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Endometrial polyp



Endometrial polyp
Classification & external resources
ICD-10 N84.0
ICD-9 621

An endometrial polyp or uterine polyp is a polyp or lesion in the lining of the uterus (endometrium) that takes up space within the uterine cavity. Commonly occurring, they are experienced by up to 10% of women.[1] They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).[1][2] Pedunculated polyps are more common that sessile ones.[3] They range in size from a few millimeters to several centimeters.[2] If pedunculated, they can protrude through the cervix into the vagina.[1][4] Small blood vessels may be present in polyps, particularly large ones.[1]

Additional recommended knowledge

Contents

Cause and symptoms

No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen.[2] They often cause no symptoms.[3] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.[2][5] Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.[6] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.[4]

Diagnosis

Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.[2] Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium).[1] Larger polyps may be missied by curettage.[7]

Treatment

Polyps can be surgically removed using curettage or hysterescopy.[8] When curettage is performed, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure.[6] During hysterescopy, the polyp can be visualized and removed through the cervix. If it is a large polyp, it can be cut into sections before each section is removed.[6] If cancerous cells are discovered, a hysterectomy may be performed.[2] A hysterectomy would usually not be considered if cancer has been ruled out.[6] Whichever method is used, polyps are usually treated under general anesthetic.[7]

Prognosis and complications

Endometrial polyps are usually benign although some may be precancerous or cancerous.[2] About 0.5% of endometrial polyps contain adenocarcinoma cells.[9] Polyps can increase the risk of miscarriage in women undergoing IVF treatment.[2] If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.[2] Although treatments such as hysterescopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.[6]

Risk factors and epidemiology

Endometrial polyps usually occur in women in their 40s and 50s.[2] Risk factors include obesity, high blood pressure and a history of cervical polyps.[2] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.[2][10] Endometrial polyps occur in up to 10% of women.[1] It is estimated that they are present in 25% of women with abnormal vaginal bleeding.[10]

Structure

Endometrial polyps can be solitary or occur with others.[11] They are round or oval and measure between a few millimeters to several centimeters in diameter.[11][6] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.[6] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium.[6] If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall.[11] Pedunculated polyps are more common than sessile ones.[3]

See also

References

  1. ^ a b c d e f Bates, Jane (2007). Practical Gynaecological Ultrasound. Cambridge University Press, 65. ISBN 1900151510. 
  2. ^ a b c d e f g h i j k l Uterine polyps. MayoClinic.com (2006-04-27). Retrieved on 2007-10-20.
  3. ^ a b c Sternberg, Stephen S.; Stacey E. Mills, Darryl Carter (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins, 2460. ISBN 0781740517. 
  4. ^ a b Dysmenorrhea: Menstrual abnormalities. Merck Manual of Diagnosis and Therapy (2005). Retrieved on 2007-10-20.
  5. ^ Endometrial Polyp. GPnotebook. Retrieved on 2007-10-20.
  6. ^ a b c d e f g h DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional, 703. ISBN 0838514014. 
  7. ^ a b Macnair, Trisha. Ask the doctor - Uterine polyps. BBC Health. Retrieved on 2007-10-21.
  8. ^ Uterine bleeding - Signs and Symptoms. UCSF Medical Center (2007-05-08). Retrieved on 2007-10-20.
  9. ^ Rubin, Raphael; David S Strayer (2007). Rubin's Pathology: Clinicopathologic Foundations of Medicine, 806. ISBN 0781795168. 
  10. ^ a b Edmonds, D. Keith; Sir John Dewhurst (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing, 637. ISBN 1405156678. 
  11. ^ a b c Bajo Arenas, José M.; Asim Kurjak (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis, 502. ISBN 184214331X. 
 
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Endometrial_polyp". A list of authors is available in Wikipedia.
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