Uterine polyp
| Endometrial polyp | |
 | |
|---|---|
| Endometrial polyp, viewed by sonography. | |
| ICD-10 | N84.0 |
| ICD-9 | 621 |
|
WikiDoc Resources for Uterine polyp |
|
Articles |
|---|
|
Most recent articles on Uterine polyp Most cited articles on Uterine polyp |
|
Media |
|
Powerpoint slides on Uterine polyp |
|
Evidence Based Medicine |
|
Clinical Trials |
|
Ongoing Trials on Uterine polyp at Clinical Trials.gov Trial results on Uterine polyp Clinical Trials on Uterine polyp at Google
|
|
Guidelines / Policies / Govt |
|
US National Guidelines Clearinghouse on Uterine polyp NICE Guidance on Uterine polyp
|
|
Books |
|
News |
|
Commentary |
|
Definitions |
|
Patient Resources / Community |
|
Patient resources on Uterine polyp Discussion groups on Uterine polyp Patient Handouts on Uterine polyp Directions to Hospitals Treating Uterine polyp Risk calculators and risk factors for Uterine polyp
|
|
Healthcare Provider Resources |
|
Causes & Risk Factors for Uterine polyp |
|
Continuing Medical Education (CME) |
|
International |
|
|
|
Business |
|
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 than 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, particularly in large polyps.[1]
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 missed 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] Untreated, small polyps may regress on their own.[10]
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][11] The use of an IntraUterine System containing levonorgestrel in women taking Tamoxifen may reduce the incidence of polyps.[12] 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.[11]
Structure
Endometrial polyps can be solitary or occur with others.[13] They are round or oval and measure between a few millimeters to several centimeters in diameter.[13][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.[13] Pedunculated polyps are more common than sessile ones.[3]
See also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Bates, Jane (2007). Practical Gynaecological Ultrasound. Cambridge University Press. p. 65. ISBN 1900151510.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 "Uterine polyps". MayoClinic.com. 2006-04-27. Retrieved 2007-10-20.
- ↑ 3.0 3.1 3.2 Sternberg, Stephen S. (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins. p. 2460. ISBN 0781740517. Unknown parameter
|coauthors=ignored (help) - ↑ 4.0 4.1 "Dysmenorrhea: Menstrual abnormalities". Merck Manual of Diagnosis and Therapy. 2005. Retrieved 2007-10-20.
- ↑ "Endometrial Polyp". GPnotebook. Retrieved 2007-10-20.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 DeCherney, Alan H. (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0838514014. Unknown parameter
|coauthors=ignored (help) - ↑ 7.0 7.1 Macnair, Trisha. "Ask the doctor - Uterine polyps". BBC Health. Retrieved 2007-10-21.
- ↑ "Uterine bleeding - Signs and Symptoms". UCSF Medical Center. 2007-05-08. Retrieved 2007-10-20.
- ↑ Rubin, Raphael (2007). Rubin's Pathology: Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 806. ISBN 0781795168. Unknown parameter
|coauthors=ignored (help) - ↑ Kaunitz, Andrew M. (2002-08-26). "Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer?". Medscape Ob/Gyn & Women's Health. Retrieved 2008-04-20.
- ↑ 11.0 11.1 Edmonds, D. Keith (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing. p. 637. ISBN 1405156678. Unknown parameter
|coauthors=ignored (help) - ↑ "Intrauterine Levonorgestrel Protects Against Uterine Effects of Tamoxifen". BJOG. 2007 (114): 1510-1515. Retrieved 2008-04-20.
- ↑ 13.0 13.1 13.2 Bajo Arenas, José M. (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis. p. 502. ISBN 184214331X. Unknown parameter
|coauthors=ignored (help)