Why polyps appear in the uterus and should they be removed

What are endometrial polyps and what they are

The inner surface of the uterus is covered with endometrium. It is to him that the fertilized egg should attach, and it is he who is separated with the blood during menstruation, if conception did not happen.

Normally, the endometrium is smooth. But sometimes outgrowths appear on it, ranging in size from a sesame seed to a golf ball and even larger. These are endometrial polyps. Inside they have connective tissue and blood vessels, so they do not disappear during menstruation and continue to grow.

One or more polyps may appear in the uterus. And they can look completely different. Some stretch out on a thin leg and hang like a pear into the uterine cavity or go out into the vagina. Others form a wide base, protrude in the form of a tubercle.

In addition, they may have a different histological structure. That is, some have the correct order of layers of normal cells, while others have tortuous vessels, disrupted tissue structure and cells that can degenerate into cancer.

Polyps can occur at any age, but are most common in women in their 40s and 50s.

Why do polyps appear in the uterus

Scientists believe that the main cause of endometrial polyps is an increase in estrogen levels. If there are too many of them in the blood, this is absolute hyperestrogenism. But more often it is relative, when estrogens are normal, and there is not enough progesterone. This just happens after 40 years: when ovulation stops, progesterone ceases to be produced.

Studies say that hyperestrogenism, which means polyps, most often appear when:

Overweight. Estrogen is produced not only by the ovaries, but also by the adipose tissue. While it is not enough, the hormonal background does not suffer. And when there is a lot, problems begin.
Arterial hypertension. It usually occurs in overweight women.
Taking tamoxifen. It is prescribed for the treatment of breast cancer. It blocks estrogen receptors in cells and prevents it from stimulating tumor growth. But the hormone remains in the blood, so it looks for other points of application and finds the endometrium in the uterus.
Hormone replacement therapy in postmenopausal women. In this case, estrogens are introduced into the body.

With chronic inflammation of the uterus, polyps can also appear, due to the fact that endometrial cells begin to divide incorrectly.

Why are endometrial polyps dangerous?

Most often, an endometrial polyp is a benign formation. It cannot grow into surrounding tissues, does not give metastases, its cells do not differ in structure from the rest of the mucous membrane. But there is always a risk of complications:

Rebirth into cancer. According to statistics, the transition to a malignant tumor occurs in 5.6% of women with atypical endometrial polyps. This is a type of formation in which the cells have an immature structure, an altered nucleus and an irregular arrangement in the layers of tissue.
Chronic anemia. Polyps cause uterine bleeding. If it is repeated often, the level of hemoglobin in the blood decreases.
Infertility. It is believed that polyps can prevent sperm from entering the fallopian tube or prevent an embryo from implanting into the wall of the uterus. Infertility is associated with polyps in 3, 8–38, 5% of cases.

What are the symptoms of polyps in the uterus?

Often polyps do not cause any inconvenience at all; they are accidentally found during examination. But sometimes symptoms appear in which you need to consult a gynecologist:

The menstrual cycle is lost: a different number of days pass between periods each time, the cycle has become more than 35 or less than 21 days.
Spotting spotting or heavy bleeding occurs between periods.
Menopause long ago, but suddenly there was blood on the underwear.
Menstruation is noticeably heavier and more pads or tampons have to be used.
Attempts to conceive are not successful.

Go to the gynecologist immediately or call an ambulance if the pad overflows and leaks in less than 2 hours. This is a sign of severe uterine bleeding that can be life threatening.

How endometrial polyps are diagnosed

The polyp is almost impossible to notice during a gynecological examination. An exception is if it is large and comes out of the cervix. Therefore, special diagnostics are needed:

Transvaginal ultrasound. It is done on the 10th day of the menstrual cycle. The research method is quite simple, but not always accurate: a polyp can be overlooked or confused with a fibroid. Therefore, additional examination is needed.
Doppler, or color Doppler mapping. A special ultrasound mode that shows the blood flow in the vessels in blue and red colors. Helps locate the artery feeding the polyp.
Sonohysterography. An ultrasound method, for which saline is pumped into the uterus. The fluid expands the cavity, helps to distinguish polyps from fibroids and to see even small formations: they will sway from the movement of water.
Hysteroscopy. A flexible tube with a video camera is inserted into the woman's uterus under anesthesia. The method helps to examine the polyp and the entire uterus, make a biopsy - take some tissue for examination under a microscope. During diagnostic hysteroscopy, you can remove the polyp.

It will be possible to say exactly about the structure of the polyp, to assess the risk of degeneration into cancer only after studying its tissues during a histological examination.

How are polyps in the uterus treated?

Differently. The gynecologist will remove the neoplasm, prescribe medication or offer to wait. Some studies say that a polyp up to 10 millimeters, which is not bothering, can simply disappear within a year. You just need to be regularly monitored by a doctor.

Removal of a polyp

Scientists still have not decided whether to remove all endometrial polyps. But with bleeding, planning a pregnancy, and irregularities in the cycle, doctors recommend removing even small neoplasms. This will help bring your period back to normal.

There are three methods for removing a polyp:

Curettage of the uterus. Under anesthesia, using a special metal loop, the entire mucous membrane of the uterus is removed and sent for histological examination. The method is suitable for small polyps.
Hysteroscopy. This is the main method of treatment. The doctor can see the location of the polyp, gently remove the polyp with an electric loop and cauterize its base. After surgery, slight bleeding may persist for 1–2 days.
Uterus removal. It is used if malignant cells have been found in the polyp. This will help protect against cancer and death.

Drug treatment

Gynecologists prescribe hormones in pills or injections, or put a hormonal coil. The goal is to reduce the production of your own estrogens or block their effect on the endometrium.

But the effect of all this is temporary. While the woman receives hormones, the size of the polyps decreases, the symptoms disappear, and as soon as it stops, everything becomes the same.

Therefore, medications are prescribed if you need to postpone the operation for several months or immediately after removal of the polyp in order to reduce the risk of relapse.