Any mass that attaches to the lining of the uterine cavity by means of a slender tip can be clinically referred to as a uterine polyp. Thus, polyp-like masses in the uterine cavity may be submucosal fibroids with tissues, endometrial polyps, adenomyoma-like polyps and malignant polyps (cancer or sarcoma). The causes of endometrial polyp formation may be related to inflammation, endocrine disorders, especially high estrogen levels. Most scholars believe that polyps come from the immature endometrium, especially the basal part. Symptoms: The main symptoms are increased menstrual flow or irregular uterine bleeding; polyps are seen or palpated at the cervical opening and the uterine body is slightly enlarged; hysteroscopy or segmental scraping and sending the removed tissues or polyps for pathological examination can clarify the diagnosis and differentiate it from dysfunctional uterine bleeding, submucosal fibroids and endometrial cancer.
Hysteroscopy, endometrial polyps mostly occur at the bottom of the uterus, such as the size of a small finger, fatty or peachy color, translucent. When pressure is applied to the uterus, the polyp trembles and does not fall off, so a biopsy can be taken at this time to clarify the diagnosis.
Etiology: The reason for the formation of polyps may be related to inflammation, endocrine disorders, especially high estrogen levels. Most scholars believe that polyps come from the immature endometrium, especially the basal endometrium.
The four main causes of uterine polyps are as follows.
1, chronic endometritis or myometritis.
2.Uterine cavity foreign body such as IuD, foreign body retention.
3, atopic infections such as tuberculosis, amoeba and schistosomiasis.
4.Placental residue complicating infection.
The mechanisms of infertility caused by uterine polyps are as follows.
1, polyps fill the uterine cavity and prevent the sperm and pregnant egg from staying and implanting.
2, polyps combined with infection, changing the intrauterine environment, which is not conducive to the survival of sperm and pregnant eggs.
3. Polyps prevent placental implantation and embryonic development.
4. Combined with tubal or ovarian inflammation, it may cause obstructive or anovulatory infertility.
Clinical manifestations.
1. Menstrual disorders High volume, prolonged periods, dysmenorrhea and irregularity.
2. Primary or secondary infertility.
3. Symptoms of enlarged uterus, lower abdominal cramps, increased leucorrhea and post-coital bleeding.
Examination: The following tests are often done to diagnose endometrial polyps clinically.
1, gynecological examination: acute inflammation can be seen as cervical congestion and edema, or erosion, with purulent discharge white cervical canal discharge, there can be pain when touching the cervix. Chronic cervicitis can be seen in the cervix with varying degrees of erosion, hypertrophy, polyps, glandular cysts, ectopia and other manifestations, or see the cervical mouth with purulent discharge, palpation of the cervix is harder. In case of cervical erosion or polyp, there may be contact bleeding.
2.Microscopic examination: endometrial polyp consists of endometrium, covered with a layer of cuboidal epithelium or low columnar epithelium. The middle part of the polyp forms a fibrous longitudinal axis, which contains blood vessels. Due to the narrowed tip and reduced blood supply, polyps are highly susceptible to degeneration. The polyp is most prone to intravascular thrombosis and turns dark purple due to stasis of blood, and necrosis often starts to occur at the tip, which may eventually rot and fall off.
3.Cervical smear shows Pap II.
4.For more serious cases, cervical biopsy can be done to clarify the diagnosis.
The pathological diagnostic criteria for polyp malignancy are.
① the whole polyp must be seen in its entire form.
②Malignant lesions are confined within the polyp.
③ The endometrium around the polyp is not cancerous in, and should be distinguished from endometrial adenocarcinoma showing polyp-like growth.
The treatment plan is based on the size, location, morphology of the polyp and the age of the patient, different treatment methods are adopted.
1, For larger and tipped polyps, they can be seen or felt in the lower part of the uterus, at which time they can be removed by dilating the cervix, followed by cervical and uterine cavity scratching to scrape out the rest of the polyps and send them for pathological examination.
2, small focal or diffuse polyps scraping, attention should be paid to comprehensive scraping, especially at the bottom and corner of the uterus.
3, after the uterine surgery, anti-infection treatment should be carried out. Clinical antibiotics can be given orally or by static drip.
4.For those who have obvious bleeding symptoms and cannot be eradicated or recur frequently by the above treatment, hysterectomy should be considered.
Preventive measures: Although the polyp is removed, the chronic inflammation of the uterus is not removed, and the pathogenic bacteria are still lurking in the cervical tissue, which means the cause of the disease still exists. Therefore, after the removal of uterine polyps, the chronic inflammation of the uterus should also be treated to prevent the recurrence of polyps. When polyps are large or combined with severe inflammation, partial or total hysterectomy should also be considered. After uterine polyp surgery, you should also go to the hospital for regular review as prescribed by the doctor, because recurrence can still occur when there is inflammation or when there are smaller and deeper polyps that are not removed together. Regular check-ups can detect new recurrent lesions as early as possible to facilitate timely symptomatic treatment, eliminate hidden problems and ensure good health.
The impact of endometrium on infertility endometrial polyps are mostly caused by the development of chronic endometritis or myometritis, and may also be due to foreign bodies in the uterine cavity, placental residues and concurrent infections, etc. Endometrial polyps are another type of chronic endometritis, that is, inflammatory endometrial local vascular and connective tissue hyperplasia, the formation of polyp-like redundancies into the uterine cavity, polyps vary in size and number, mostly located in the uterine body, cervical The endometrial polyps may cause dilatation of the cervical canal and prolapse out of the external opening. The endometrial polyp may cause dilatation of the cervical canal and prolapse out of the ectocervix. The combination of infection alters the intrauterine environment, which is not conducive to the survival of sperm and eggs. Combined tubal or ovarian infections may cause obstructive or anovulatory infertility.