My name is Natalia Kotsabin, I am the chief doctor at Damia Medical Center, but my main vocation is to help couples feel the joy of having a baby!
The Art of Hysteroscopy based on the basis of our clinic has been operating for more than 4 years, where we teach doctors from all over Ukraine this minimally invasive technique every month.
Hyperplasia and endometrial polyps are quite common when seen by a gynecologist. All appeals can be divided into two scenarios. In the first case, the woman is not worried, but a preliminary ultrasound examination reveals or suspects pathology of the uterine cavity. In the second case, the woman addresses complaints that have been bothering her for some time. These are usually heavy and painful menstruation, the appearance of clots in menstrual secretions; bloody discharge between periods; increase in the duration of menstruation; the appearance of lower abdominal pain.
What is endometrial hyperplasia and uterine polyps?
Endometrial hyperplasia is a benign growth of the uterine mucosa, ie its inner layer – the endometrium. The condition is dangerous because under certain circumstances, malignant cell degeneration can occur. With hyperplasia, different parts of the mucosa may have different degrees of damage. In addition, prolonged menstruation can lead to anemia in endometrial hyperplasia.
It is extremely important not just visual assessment during ultrasound , but also targeted histological assessment of hyperplasia of the endometrium. This assessment can only be performed by hysteroscopy: when the doctor sees the surface of the endometrium and can aim to take a fragment of the tissue from the place that visually looks most affected.
An endometrial polyp is a growth on the lining of the uterus. The size of polyps can range from 2-3 millimeters to several centimeters. It can be both single and multiple (polyposis).
Where do endometrial hyperplasia and polyps come from?
There are several explanations for the occurrence of all benign hyperplastic processes in the uterine cavity:
The first is a long-term hormonal imbalance of sex hormones: an excess of estrogen and a decrease or absence of progesterone in the second phase of the menstrual cycle. This happens when for a long time, for example, six months – a year of full ovulation!
The second – chronic inflammatory process of the uterine mucosa – endometritis. Although there are many publications that it is endometrial polyps that lead to dysbiosis – a violation of the balance between healthy and pathogenic microflora in the endometrium. This further exacerbates the inflammatory process.
In any case, you need to conduct additional testing before recommending surgical removal or anticipatory tactics.
- First of all – ultrasound,
- Hysteroscopy, which is performed when any pathology of the uterine cavity is suspected
Complaints that most often bother a woman with endometrial hyperplasia or endometrial polyps:
- Heavy menstruation, the appearance of clots in menstrual secretions.
- Bloody discharge between periods;
- Occurrence of painful menstruation
- Prolonged menstruation
- Lower abdominal pain
- Blood secretion during sexual intercourse
- Lower abdominal pain
- AND ALSO – INFERTILITY, BECAUSE POLYP acts as a “foreign” body in the uterine cavity. With hyperplasia, embryo implantation is also not possible.
Is it necessary to treat endometrial hyperplasia and polyps?
In the case of hyperplasia, the main thing is a targeted histological evaluation of the hyperplasia of the endometrium to exclude the malignant process. Treatment depends on the histological conclusion. And in the vast majority it is not surgical, but hormonal.
There is good news about endometrial polyps – they rarely turn into malignant. Although there are no clear predictors (predictors) that can predict the degeneration of benign to malignant. Therefore, when this pathology is detected, there is a clear recommendation for removal and further histological diagnosis.
Polyps of the uterine cavity must be removed surgically. Only polyps smaller than 1 cm can be observed (Annan JJ, AquilinaJ, BallE. The management of endometrial polyps in the 21st century. The Obstetrician & amp; Gynecologist 2012; 14: 33–38).
In no case blind scraping is allowed! This is a “crime” against the uterus. With this method it is IMPOSSIBLE to remove the entire polyp, its bed, and the probability of recurrence is very high.
Only hysteroscopy is used for removal.
The removed polyp must be sent for histological diagnosis.
And finally, most importantly – most polyps require postoperative hormonal treatment.
Take good care of your health!
If you have any questions, I will be happy to help you!