Types of endometrial polyps: simple, fibrous, cystic

The growth of tissues above the endometrial mucosa is a polyp. Consider the main causes of its appearance, symptoms, types, methods of diagnosis and treatment.

Endometrial polyp is a fairly common gynecological anomaly that affects about 10% of women at a young age and more than 40% after menopause. Endometrium is a mucous layer of the uterine cavity, richly supplied with blood vessels. It consists of several structures and performs the function of optimal implantation of the blastocyst in the uterus. It is also part of the placenta, which supplies the embryo with oxygen and nutrients.

Significant causes of neoplasia have not been established, but there are a number of factors that can cause it:

• Hormonal imbalance.
• Age over 35 years.
• Endometriosis, fibromyoma.
• Chronic inflammatory processes in the uterus and its structures.
• Endocrine pathology.
• Frequent abortions, miscarriages.
• Obesity and hypertension.
• Long-term use of sex hormones, glucocorticosteroids.
• Incomplete removal of the placenta after an abortion, childbirth.
• Long standing intrauterine device.
• Surgical interventions on the ovaries, uterus.
• Ectopic hormone-producing tumors.
• Diseases of the liver, intestines, biliary tract.
• Disruption of the immune system of the body.
• Prolonged stress conditions and psychological stress.
• Hereditary factor.

Local intrauterine neoplasm arises from the pathological proliferation of cells of the functional or basal layer of the uterine lining. Galls can form on an unchanged shell or against a background of hyperplastic processes.

Types of polyps by etiology:

1. The functional layer of the endometrium is most susceptible to changes in the period of the menstrual cycle. In the absence of fertilization, it is rejected from the basal layer. In case of incomplete rejection, a functional polyp is formed, which consists of glandular and stromal cells. During the period of menstruation, the growth is subjected to the same changes as the whole layer of the endometrium.
2. Glandular and glandular cystic growths with or without adenomatous changes form from the cells of the basal layer. If neoplasia occurs in the isthmic part of the uterus, it usually consists of cells characteristic of the mucous membrane of the internal orifice of the neck of the organ, that is, endometrial or epithelial tissues.

The main types of polyps according to histological (pathological-morphological) characteristics:

1. Fibrous - formed from cells of fibrous connective tissue. May contain collagen fibers, single glands or non-functional epithelial cells. Consists of vessels with thickened sclerotic walls.
2. Glandular fibrous - is very rare and usually in women with stable menstruation. Consists of glands of different lengths and shapes, the lumens of which are unevenly expanded or stretched. In the upper layers of the tumor is a large number of stromal cells. Closer to the base, the build-up structure is denser and may consist of fibrous tissue. The walls of blood vessels are thickened and sclerosed. There are circulatory disorders and inflammatory processes.
3. Adenomatous - develops extremely rarely and is characterized by an increased proliferation of glandular tissues throughout the polyp with focal ingrowths from the glands of epithelial cells with a modified structure. May contain morphological structures of other types of polyps.

Despite the variety of forms, the clinical signs of pathology do not have specific features. Based on this, the symptoms of growth are largely dependent on its type, size and location in the uterine cavity.

Common symptoms for all types of endometrial polyps:

• Whitish discharge from the genital tract.
• Violation of the menstrual cycle.
• Bleeding after exercise or intercourse.
• Pain during intercourse.
• Smearing and heavy bleeding in the postmenopausal period.
• Pain in the lower abdomen.
• Infertility.

The main method for diagnosing local intrauterine lesions is abdominal and transvaginal ultrasound. The obligatory complex of researches includes hysteroscopy with scraping. Diagnostic curettage is necessary for further pathological examination of tissues. Treatment depends on the size and number of neoplasias. If it is a single tumor, then it can be removed in laboratory conditions under local anesthesia.

Which endometrial polyp is the most dangerous?

Polyps are benign lesions in the uterus, caused by the growth of its inner layer. Such growths can be both single and multiple. Their sizes are from 1-2 mm to 80 mm and more, as a rule, this is an oval / round tumor on a pedicle or a broad base. One of the features of growths is that they do not cause vivid clinical symptoms. Confirm their presence is possible only with the help of instrumental methods.

The danger of polyps of any kind is that over time they can degenerate into malignant tumors. That is why regular gynecological examinations are necessary. The rebirth of growths occurs under the action of various factors:

• Exchange violations.
• Decreased defenses of the immune system.
• Acute and chronic diseases of the body.
• Various intoxications.
• Unfavorable environmental conditions.
• Emotional tension and more.

Any of the above factors, as well as their interaction leads to the fact that cells change their features. Fabrics become atypical, undifferentiated and begin to actively grow. The presence of abnormal cells indicates malignant degeneration. After a comprehensive diagnosis, the patient is prescribed long-term therapy according to the rules of oncology treatment.

Another danger of local intrauterine lesions is infertility. Very often growths appear with hormonal disorders, which in turn cause problems with the menstrual cycle. With timely diagnosis, they are removed, and the woman is prescribed rehabilitation therapy with hormones. This allows you to normalize reproductive functions.

It should also be noted that all types of endometrial polyps are accompanied by prolonged and frequent bleeding. It can be abundant periods after a long delay or intermenstrual bleeding, bleeding. In any case, during blood loss along with erythrocytes, the organism also leaves hemoglobin (protein and iron).

Against this background, iron deficiency anemia may develop. A woman complains of constant weakness, headaches and dizziness, general malaise. Due to lack of oxygen, all tissues and organs are affected. The treatment consists of hormonal correction, surgical removal of tumors in the uterus and rather long treatment of anemia.

Simple polyp endometrium

Inside the uterine cavity is lined with mucous membrane, that is, endometrium. It consists of a basal and functional layer. During the menstrual cycle of the basal layer grows functional. If fertilization does not occur, he is rejected during the next menstruation.

A simple polyp of the endometrium is formed when incomplete rejection of the functional layer. Very often this occurs on the background of hyperplasia and polycystic ovary syndrome. Local intrauterine growth may consist of cells of both basal and functional structure.

• Functional growths have a rounded or oblong shape, ranging in size from 1-2 mm to 8 mm or more. May be rejected during menstruation, therefore, do not require treatment and removal.
• The outbreaks of the basal layer are not rejected during menstruation and are not affected by drugs, therefore, require surgical removal (hysteroresectoscopy).

Most often, tissue proliferation causes no symptoms. But in some cases there are intermenstrual bleeding, prolonged menstruation, spotting and pain after intercourse or physical activity, infertility.

A simple polyp of the endometrium is diagnosed by ultrasound. Ultrasound carried out before and after menstruation. This allows you to set the type of growth: functional, basal. For treatment can be prescribed drugs that improve endometrial rejection. If an ultrasound revealed no neoplasia, but there are signs of its presence, then an aspiration biopsy and curettage are indicated. The resulting tissue is sent to the histology on the results of which make a plan for further therapy.

Fibrous endometrial polyp

This type of neoplasm refers to benign connective tissue tumors that grow from the inner lining of the uterine cavity. One of the features of the fibrous endometrial polyp is that it is formed by connective tissue. In rare cases there are glandular cells in its composition.

The buildup can be on a pedicle or a broad base, both single and multiple. Most often located at the bottom of the uterus or in the mouths of the fallopian tubes. Sizes range from microscopic 1-2 mm to large 5-8 cm or more.

If polyps are small in size, they are asymptomatic and can only be detected by ultrasound. When large growths appear intermenstrual bleeding, prolonged irregular menstruation, discharge during menopause and postmenopausal. There may be cramping and pulling pain in the lower abdomen and a general deterioration of health.

In most cases, fibrous growths are formed against the background of hormonal disorders and due to low levels of estrogen. Also causes of the disorder include:

• Chronic endometritis - inflammation of the mucous membrane provokes a violation of the trophic tissue and causes hyperplastic processes.
• Complications during labor and termination of pregnancy.
• Endometrial injuries caused by prolonged use of the intrauterine device after diagnostic or therapeutic procedures.
• Endocrine and vascular diseases.
• Reduced immunity.

Neoplasia is formed in violation of humoral and cellular immunity. The basis of the pathological process are local inflammatory, atrophic and post-traumatic processes that ensure tissue growth.

Diagnosis begins with a gynecological examination of the patient and anamnesis. After this, an ultrasound and contrast radiography of the uterus are performed. The complex of mandatory tests includes hysteroscopy with histology. Fibrous tissues differentiate with other forms of neoplasms of the body and cervix.

Fibrous polyp has a low level of vascularization and proliferation. Such growths are insensitive to hormones, so hormonal correction is ineffective. For treatment, curettage of the uterus, hysteroresectoscopy is performed.

The risk of their malignancy is about 0.5%. But without treatment, they can cause infertility. Necrosis is also possible, because under the influence of infectious agents or in the process of infringing tissue, growths can die off and decompose. The pathological process proceeds with inflammation and acute intoxication.

[1]

Endometrial Cystic Polyp

The inner surface of the uterus is the endometrium. It is rejected during the menstrual cycle and goes along with bleeding. But due to the action of some factors, the mucous membrane does not completely depart, which leads to damage to its structure and intensive growth. Cystic growths of a benign character form on it.

These tumors are a cystic polyp of the endometrium. Neoplasia contains a mucous secret that accumulates in the lumens of the twisted glands and gradually increases in size.

Causes of pathology:

• Adrenal and thyroid dysfunction.
• Diabetes.
• Hypertension.
• Obesity.
• Genetic predisposition.

The main symptoms of the disease:

• Failures of the menstrual and ovulatory cycle.
• Discharge from the genital tract before or after menstruation.
• Abundant uterine bleeding, not associated with the menstrual cycle.
• Pain in the lower abdomen.
• Dizziness and general weakness.
• Discomfort and pain during sexual intercourse.
• Infertility.

The appearance of the above symptoms are the reason for going to the doctor and undergoing a comprehensive gynecological examination. The main diagnostic method is ultrasound examination of the uterus.

Surgical treatment, polyps are removed by surgery (hysteroscopy). The place of their growth is treated by cryosurgery using liquid nitrogen. Also shown is scraping the mucosal surface to reduce the risk of recurrence. The patient is prescribed hormone therapy, which is aimed at restoring the normal functioning of the reproductive system.

[2]

Endometrial adenomatous polyp

Another type of endometrial polyp is adenomatous local intrauterine lesions. In addition to the uterus, such growths can form in the rectum and colon, on the mucous membrane of the stomach, intestines. Externally, neoplasia can be in the form of tubercle or stand on the leg.

Adenomatous type contains a glandular epithelium with signs of proliferation, that is, a structural reorganization of the glands. One of the peculiarities of such education is that it has the prerequisites for developing into endometrial cancer.

Causes of pathology:

• Complications of surgical intervention, abortions, miscarriages, scraping.
• Chronic inflammatory processes in the uterus.
• Hormonal disbalance.
• Venereal diseases.
• Decreased immune system.
• Hereditary predisposition
• Incorrectly installed or long-standing intrauterine device.

Symptoms of pathology are manifested by menstrual disorders, intermenstrual bleeding, an increase in the amount of discharge during menstruation. Possible lower abdominal pain, which is given to the intestine. When intercourse occurs discomfort and pain. Such symptoms are a reason for immediate treatment.

Without timely diagnosis and treatment, an adenomatous polyp can cause infertility and malignant degeneration. Treatment is prompt. The gynecologist-oncologist estimates the size of the growth, if its size is more than 2 cm, then the risk of developing cancer is about 10-20%. During the surgical procedure, the uterine cavity is scraped out, removing the neoplasm. After that, comprehensive rehabilitation therapy is prescribed.

Particular attention should be paid to preventive measures. It is recommended to undergo regular gynecological examinations, exclude casual sex and bad habits. It is necessary to protect against unwanted pregnancy and subsequent abortion with uterine trauma.

Functional polyp of the endometrium or functional polyp

The endometrial polyp is a growth on the inner lining of the uterine cavity. It is formed due to abnormal growth of tissues. Functional or pseudopoly affects only the stroma of the endometrium. It is formed by incomplete rejection of the mucous during menstruation. Tumor neoplasms may change during a cycle. Its cells respond to the action of sex hormones and surrounding tissues.

According to the histological features, a functional type build-up has several types:

• Hyperplastic - comes from epithelial cells.
• Proliferative - active growth of mucosal tissues due to the inflammatory process.
• Secretory - cell proliferation is associated with increased secretion of secretory fluid.

The causes of neoplasia are associated with local and general hormonal disorders. One of the reasons is local estrogenia, that is, increased estrogen activity against the background of progesterone deficiency. This deviation develops with endocrine disorders, stress, hypertension, overweight, gynecological diseases, inflammation or injury of the uterine lining, disorders in the process of tissue repair.

About 10% of women are unaware of damage to the mucous membrane of the uterus. This is due to the lack of symptoms due to the small size of growth. As its tissues grow, such pathological signs appear:

• Soreness during menstruation.
• Disorders of the menstrual cycle.
• Spotting in the intermenstrual period, during menopause, postmenopausal.
• Pulling pains in lower abdomen.
• Pain during intercourse.
• Blood spotting after sex.

The appearance of the above symptoms is the reason for the appeal to the gynecologist. The doctor conducts an examination and ultrasound of the uterus. Medical diagnostic laparoscopy is shown for accurate diagnosis and determination of the type of neoplasm. Also, the patient is prescribed a blood test for sex hormones (testosterone, progesterone, prolactin, estradiol). Tissues taken during laparoscopy are sent for histology to confirm their benign nature.

[3]

Focal endometrial polyp

Local growth of the uterine lining is a polyp. The centers can be single and multiple. In most cases, the neoplasia is small. At the same time, neoplasms that have re-formed after resection can occur.

A focal polyp of the endometrium develops under the influence of various factors. Possible causes of the disease include:

• Hormonal disorders.
• Violations in the ovaries.
• Trauma endometrium.
• Endocrine diseases.
• Inflammatory diseases of the reproductive system.
• Stress.

The size of the neoplasia often does not exceed 10 mm, because of which the symptoms of pathology are blurred. But as the tissue grows, the following symptoms occur:

• Various violations of the menstrual cycle.
• Uterine bleeding, not associated with menstruation.
• Spotting and pain after intercourse.
• Increase the amount of normal discharge (run a thick consistency with a white tint).

If a neoplasm is suspected, a complex of diagnostic studies is conducted with a mandatory ultrasound of the uterus. If the growth is localized in the cervical canal, then it is visible when examining the orifice of the cervical organ. To determine its structure, histology of tissue scraping is shown.

If you delay with a visit to the doctor and diagnostics, then the growth of tissues can cause a number of complications: post-hemorrhagic anemia, severe bleeding, uterine myoma, infringement of the neoplasm, hyperplasia, endometrial cancer, polyp necrosis with ischemic changes.

Treatment depends on the type of focal growth, patient's age and a number of other factors. The neoplasm can self-absorb after menopause. In all other cases, surgical treatment, taking medication and monitoring the patient's condition is indicated.

Basal endometrial polyp, or basal-type polyp

A local intrauterine device that affects the basal layer of the endometrium is a polyp. In most cases, the growth is benign, but under the influence of certain factors it can turn into oncology. Basal polyps are single and multiple. They are diagnosed in 5-25% of patients regardless of age.

The neoplasm is derived from the basal layer, but contains glandular cells, stroma and myometrial tissue. If the size of the neoplasia does not exceed 1-3 cm, then the pathology is asymptomatic. But as it grows, menstrual irregularities occur, problems with conception, spotting, not associated with menstruation and other symptoms characteristic of all types of endometrial formations.

One of the features of the basal species is that, unlike the functional, it is not rejected during menstruation, that is, it is not sensitive to hormonal changes. The main method of treatment is surgery. The doctor removes the neoplasm, performs curettage of the uterine cavity, and treats the growth site with liquid nitrogen. In the future, the patient is prescribed a complex of drugs to restore the menstrual cycle and reproductive function.

[4], [5], [6]

Endometrial proliferative polyp, or proliferative type polyp

The endometrium is the mucous layer lining the uterus from the inside. Its functions include the implantation and development of the embryo. The menstrual cycle depends on changes in the mucous membrane. One of the causes of disorders in the female body is the proliferation of the endometrium. This concept implies the active process of dividing cells of the tissue of an organ. During menstruation, the mucous membranes of the uterus become thinner and the tissues of the functional layer are rejected. This process is due to proliferation.

The main phases of proliferation:

• Early - its duration from 1 to 7 day of the menstrual cycle. During this period, the uterine mucosa changes. The endometrium contains epithelial cells, the blood arteries are not active, the stroma is similar in structure to the spindle.
• Medium is a short stage from the 8th to the 10th day of the cycle. Cell structures are formed on the mucous membranes, which are formed during indirect division.
• Late - from 11 to 14 day of the cycle. Twisted glands appear on the endometrium, the epithelium is multilayered, the cell nuclei are large and round in shape.

Proliferative endometrium does not always indicate the normal functioning of the reproductive system. In some cases, proliferation is a sign of pathology, when cells actively divide, thickening the mucous layer of the uterus. Against this background, a proliferative endometrial polyp may occur.

New growth of proliferative type can be of two types - ferrous and atypical. In the latter case, the growth contains adenomatous foci that are localized in the branching glands. The transformation of glandular tissue into oncology occurs in 3 out of 100 women.

Signs of proliferative neoplasia:

• Disorder of the menstrual function of the uterus.
• Abundant uterine bleeding.
• Intense discharge outside the loop.
• Breakthrough bleeding with clots.
• Anemia, general malaise, dizziness, weakness.
• Anovulatory cycle.
• Infertility.

To diagnose a pathological condition, the gynecologist collects a history and examines the patient's complaints. A bimanual vaginal examination, smear collection and microscopy are performed. It is mandatory to conduct transvaginal ultrasound to determine the thickness of the mucous membrane and to identify its pathologies. Also shown is a hysteroscopy with a histological examination of the scraping.

Treatment depends on the type of proliferative neoplasm. Therapy can be both conservative and operational. In the first case, the patient is prescribed drugs for the correction of hormonal levels. Under the operation imply the complete removal of the deformed areas of the endometrium with curettage of the uterine cavity.

Endometrial hyperplastic polyp

Focal intrauterine tumors arise due to excessive growth of mucosal cells. Galls can be single and multiple, they differ in size, structure and localization in the organ. Endometrial hyperplastic polyp is associated with such factors:

• Oncological diseases of the genital organs and mammary glands.
• Polycystic ovary syndrome.
• Insulin resistance syndrome.
• Uterine fibroids.
• Chronic endometritis.

Hyperplastic processes are accompanied by uterine bleeding that is not associated with menstruation. Also observed bleeding during menopause. In some cases, the pathology is asymptomatic and it can be diagnosed during long unsuccessful attempts to become pregnant.

To diagnose uterine tumors, transvaginal ultrasound and curettage of the uterine mucosa are performed, followed by histology of the collected tissues. Scraping is done on the eve of menstruation. During the operation, the entire endometrium is removed, including at the bottom of the uterus and in the uterine tube corners. Scraping is performed using hysteroscopy. Further treatment depends on the histology results. If atypical cells are not detected, then hormonal correction is carried out to restore the menstrual cycle and a number of other disorders.

[7], [8], [9], [10], [11], [12], [13], [14], [15]

Polyp endometrial cervical canal

The anatomical part of the female reproductive system in the internal genital organs is the cervical canal of the cervix. The success of pregnancy and the birth process depends on his health. One of the structural pathologies of the cervical canal is polyps. Such neoplasms grow from the cylindrical epithelium of the endocervix.

The main causes of damage to the cervical canal:

• Injury during obstetric manipulations and during the labor process. Injuries are possible if the intrauterine device is incorrectly installed.
• Genital infections.
• Structural changes in the surface of the cervix - erosion, leukoplakia.
• Violation of the vaginal microflora.
• Nonspecific infection - vaginitis, endomyometritis, vulvovaginitis, cervicitis.
• Ovarian dysfunction - polyposis, myoma.
• Endocrine pathologies - diabetes, obesity, chronic stress.
• Hormonal disorders.

Pathological condition is manifested by bloody discharge and pain after intimacy. Many women have menstrual irregularities, abundant leucorrhoea (they become mucopurulent when infected). If the growth pressure on the glands of the cervical canal, then there are abundant mucous discharge. With large neoplasia, there is a pulling pain in the lower abdomen.

Without timely diagnosis and treatment, outgrowths in the cervical canal threaten women's health:

• Malignant transformation.
• The risk of uterine bleeding.
• Necrosis of the tumor and intoxication of the body.
• Hematometer
• Pregnant women have a risk of spontaneous abortion, low location of the placenta and the development of isthmic-cervical insufficiency.

In most cases, a standard gynecological examination is sufficient to detect pathology. During the study, thickened and hypertrophied walls of the cervix are determined. Focal tissue growth may overlap the channel.

Surgical treatment. The first step is scraping the entire cervical canal. There are also other operating techniques used for neoplasia: diathermocoagulation, cryodestruction, laser polypectomy. In severe cases, cervical amputation is indicated. The operation is performed with frequent recurrences and malignant tissue degeneration. Such treatment allows to preserve the reproductive functions of the patient.

[16], [17]

Endometrial polyp with focal stroma fibrosis

Chronic inflammation and ovarian dysfunction are the main causes of endometrial stromal fibrosis. Against this background, polypous neoplasms and other pathological changes in the tissues of the uterus can form.

The disease has no specific criteria. Most often, patients complain of irregular menstrual bleeding before or after menstruation, pain and discomfort in the lower abdomen. It is possible to diagnose endometrial polyp with focal fibrosis of the stroma only by transvaginal ultrasound with tissue sampling for histology.

Surgical treatment. With the help of hysteroscopy, the removal of the growth and curettage of the endometrium is carried out. The lesion is treated with liquid nitrogen. To restore the menstrual cycle and the correction of hormonal disorders, drug therapy is carried out.

Endometrial small polyps

Violation of the proliferation of uterine endometrial cells triggers a number of pathological processes, one of which is the growth of polyps. Focal hyperplasia is manifested by an abnormal growth of the uterine mucosa in the form of single and multiple growths on the pedicle or a broad base.

Single small endometrial polyps are asymptomatic, but their large number and a gradual increase in size violates the physiological processes in the uterus. Against this background, the following symptoms occur:

• Uterine bleeding.
• Disorders of the menstrual cycle.
• Lower abdominal pain.
• Pain, discomfort and bleeding after intimacy.
• Infertility.

Most often, small multiple neoplasia is localized on the posterior wall of the uterine cavity and tubular corners. As a rule, it does not go beyond the uterus, but in some cases, the pathology affects the cervical canal.

To determine the problem, the patient is examined and an ultrasound examination is performed. In the process of diagnosis, submucosal hemorrhages due to a large number of small neoplasms, marked inflammation, and hyperemia of the basal layer of the endometrium can be detected.

Surgical treatment. Small growths are removed with a curette using a hysteroresectoscope. The removed tissue is sent for histological examination to confirm their benign nature.

[18], [19]

Hormonal polyp endometrium

One of the reasons for the formation of endometrial polyps is hormonal disruptions in the body. Uterine mucosa is a target for sex hormones. Estrogens trigger the proliferative processes of the endometrium, but with progesterone deficiency, this leads to hyperplastic changes. Therefore, in most cases, the disease is associated with hyperestrogenism. Estrogens stimulate active growth of normal, hyperplastic or malignant mucosal cells.

Hormonal changes can occur at any age. But most often it is the period of pregnancy and before menopause. The symptomatology of intrauterine local neoplasms depends on their size, number and location.

Hormonal polyp endometrium has a tendency to active growth and most often refers to the functional type. Surgical treatment of pathology followed by drug therapy to restore the balance of estrogen and progesterone.

Endometrial secretory polyp

The growth of endometrial polyps is directly related to the menstrual cycle. The time period between ovulation and the onset of bleeding is the luteal phase (corpus luteum phase). Its duration is 13-14 days. The corpus luteum secretes androgens, progesterone and estradiol. With an increased level of estrogen and progesterone, the mucosal layers change. The endometrial glands proliferate and begin to secrete as the uterus prepares for the implantation of the ovum.

In the secretory stage, the endometrium increases significantly in size. Glandular cells appear in its structure, which secrete mucus, and the membrane becomes sacchy. Secretory endometrium is quite dense with a smooth surface and basal structure. Under the influence of certain factors, growths, so-called secretory (glandular) polyps, may appear on it.

A local intrauterine neoplasm may interfere with implantation of a fertilized egg. Also, the symptoms of pathology include changes in the menstrual cycle with prolonged and profuse bleeding, spotting and pain in the lower abdomen. For diagnosis, intravaginal ultrasound and a set of laboratory tests are performed. Treatment of all types of polypous formations is surgical. The second stage of therapy is hormonal correction.

[20]

Retrogressive endometrial polyp

Local intrauterine growth can form on the background of unchanged endometrium, as well as during its pathological conditions. Glandular growths appear in the stage of atrophy, hyperplasia, proliferation or retrogression, which is characteristic of premenopausal women.

The retrogressive polyp of the endometrium is characterized by a mosaic color. According to histological characteristics, it may contain atypical cells. Very often, such tumors occur on the background of inflammatory processes or circulatory disorders, which lead to dystrophic and necrobiotic changes in tissues.

[21], [22], [23], [24], [25]

False polyp endometrium

All polypous tumors are divided into true polyps and pseudopolyps. The latter include decidual (placental) growths, which are often diagnosed during pregnancy. According to the histological structure, a false polyp of the endometrium can be glandular, fibrous or adenomatous. The latter type is dangerous malignant degeneration.

True and false polyps are differentiated by ultrasound or colposcopy. The histological structure of pseudopolyps is similar to the decidual tissue of the endometrium, but there are glandular components in their structure. Between the glands wide venous sinuses with different blood filling. Ulcerations, absence of top epithelium, necrosis, or inflammatory infiltration may also occur.

[26], [27], [28], [29], [30]

Endometrial stromal polyp

The stroma is a loose connective tissue that is represented by cellular structures with vascular tangles at the base. Endometrial stromal polyp is diagnosed by histological examination. This diagnosis indicates that the structure of the pathological neoplasm is dominated by stromal components.

By its symptoms and the cause of this species does not differ from other types of polyps. His surgical treatment with the subsequent correction of hormonal levels.

In the glandular growths, the stromal component is poorly pronounced, since glandular tissue prevails. If the tumor has focal fibrosis of the stroma, the glands are located at different angles, have different lengths and sizes, then such a polyp belongs to the stromal ones. Atypical hyperplasia also contains stromal elements, but in a small amount.

Atrophic endometrial polyp

According to medical statistics, in 95% of cases, polyps in the postmenopausal period develop against the background of atrophic processes of the uterine lining. The pathological composition of such tumors corresponds to the endometrium. At the same time, the greatest degree of proliferation is observed with a combination of adenomatous and glandular structures.

An atrophic polyp is most often diagnosed in women over 50 years of age, in patients with chronic inflammatory lesions of the urogenital system. According to histology, such formations have a greater propensity for malignancy, therefore, require surgical treatment.

Endometrial polyp in menopause, menopause and postmenopausal

The main cause of uterine polyps and cervical canal is a violation of hormone production. With the onset of menopause, changes occur in the work of the hypothalamic-pituitary system. The frequency and intensity of sex hormone release is disturbed, and ovarian dysfunction develops. Against the background of physiological processes, various types of endometrial polyps can form.

• In women with menopause, glandular fibrous polyps, consisting of endometrial glands and stroma, are more common. These tumors are accompanied by pain and bleed less, because they have a capsule.

• Glandular cystic formations grow rapidly. The polyp occupies most of the uterine cavity, and its capsule merges with the surrounding tissues. Because of this, differentiation with endometrial carcinoma is carried out.

• Glandular-angiomatous (contain an increased amount of stromal elements) have an irregular capsule and shape, heterogeneous structure and increased blood flow.

Postmenopause is the period from the last menstruation, which lasts more than 5-8 years. It is characterized by a complete stop of ovarian function. This entails major changes in the female body, since the levels of estrogen and progesterone are constantly decreasing. Against the background of such changes, ovarian pathologies, hyperplasia and neoplasms in the uterine cavity can develop. The latter include polyps. Their appearance is caused by the atrophic processes of the endometrium and hormonal decline.

The disease is manifested by spontaneous uterine bleeding and abdominal pain. Treatment of polyps during menopause and postmenopausal is the same as for women of childbearing age. Surgical removal of the growth and subsequent histological examination. To prevent recurrence, the mucosa of the uterus is scraped, and the centers of excessive tissue growth are burned with a laser or liquid nitrogen. If it is determined that polyps contain atypical cells, then complete removal of the uterus is possible.

Endometrial polyp and pregnancy

As a rule, uterine mucous polyp and pregnancy are incompatible concepts, since neoplasia prevents the attachment of the ovum to the uterine walls. But in some cases, polypous growths occur after conception. Their appearance is associated with hormonal changes in the female body and such factors:

• General decrease in immunity.
• Genital infections.
• Injuries to the uterus mucosa.
• Weight loss.
• Complications after previous birth.

Most often, pregnant women detect decidual polyps that do not pose a threat to the mother or child. They pass on their own after childbirth and do not require treatment. But such tumors require constant monitoring. If the growth is formed in the cervical canal of the uterus, it can become a source of infection for the fetus, provoke premature cervical dilatation and childbirth. In this case, local antibacterial therapy is carried out.

According to the symptoms, the local intrauterine device may not manifest itself. But in some cases, women notice nagging pain in the lower abdomen, small bloody or foul-smelling vaginal discharge. Severe bleeding may indicate injury to the neoplasia.

In most cases, doctors do not touch polyps before delivery, as they can go out on their own, and during surgical intervention there is a high risk of intrauterine and septic infection. If neoplasia causes infertility, then after its removal and a course of hormonal therapy, the woman can become pregnant.

In any case, all types of endometrial polyps require timely diagnosis and treatment in order to minimize the risk of complications and their malignant transformation.

[31]