UTERINE POLYP (1):
Definition, location, symptoms

Dr. Claude Allouche, Gynecologist Polype uterin english
Ahuza Clinic, Raanana
058 726 02 64

WHAT IS IT?
A uterine polyp is a benign growth that develops from the endometrium (lining of the uterine body) or the endocervix (lining of the cervix).

These growths are benign tumors. They can be single or multiple.
A polyp can be:

  • "Pedunculated" (with a stalk of insertion)
  • Or sessile (with a broad base of implantation).
  • It can be "fibrous" or "mucous."

WHERE CAN IT BE LOCATED?
A polyp can be located:

  • In the uterine cavity (intra-cavitary polyp),
  • In the cervix (endocervical polyp),
  • Or protrude through the external opening of the cervix (polyp expelled through the cervix).

It can measure a few millimeters (micro-polyp) or occupy the entire uterine cavity.

HOW IS IT DISCOVERED?Polype2
A polyp may cause:

  • Metrorrhagia (vaginal bleeding outside of menstruation)
  • Leucorrhea (abundant vaginal discharge)
  • Infertility (rarely the sole cause)
  • However, it is often asymptomatic, meaning without any symptoms, and is discovered during a routine gynecological exam or a pelvic ultrasound.
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  • UTERINE POLYP: HOW IS IT DIAGNOSED?

    • PELVIC ULTRASOUND, preferably via the vaginal route, is most often used to visualize the polyp in the uterine cavity.
      It is preferably performed during the first part of the cycle (a few days after menstruation).

    A polyp may sometimes resemble a uterine fibroid (fibrous polyp) or endometrial cancer (atypical, irregular polyp).
    Conversely, endometrial cancer may sometimes resemble a polyp.

    The association of a polyp with endometrial cancer is more frequent after menopause.

    • SPECULUM EXAM allows the detection of cervical polyps, which are easily visualized on the cervix after the insertion of a speculum.
      When a cervical polyp is seen with a speculum, a pelvic ultrasound is performed immediately to check for other polyps inside the uterine cavity.
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    • DIAGNOSTIC HYSTEROSCOPY,
      • This is the preferred examination to confirm the diagnosis of an intrauterine polyp.
      • Direct visualization of the polyp inside the uterus is achieved by introducing a mini digital camera, 3 to 5 mm in diameter, connected to a video screen.
      • It is a reliable and painless exam performed in consultation.
      • It can also be combined with an endometrial biopsy.

     

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  • TREATMENT


  • In some cases, treatment with progestin medication may be effective (for small polyps, mucous in appearance, and non-suspicious).

    However, in general, the treatment of a uterine polyp is SURGICAL, as a polyp can become cancerous, and only histological examination (either partial analysis after an endometrial biopsy or complete analysis after removal) can definitively confirm its benign nature.

    The polyp is removed through operative hysteroscopy (hysteroscopic polyp resection).

    OPERATIVE HYSTEROSCOPY:
    This procedure is performed:

    • In the operating room
    • Under general or local-regional anesthesia (epidural or spinal anesthesia)
    • Using a larger-diameter hysteroscope than the diagnostic one, connected to a digital camera, which in turn is linked to a video screen.
    • It not only allows visualization of the polyp but also its elective removal under visual control, thanks to the introduction of surgical instruments and an electric coagulation system.
    • It can also be used to perform an endometriectomy (removal of the entire uterine lining), which is necessary in certain cases, such as in women with a risk of early cancerous lesions (postmenopausal women) or in women over 45 years old (to avoid the risk of recurrence).
    • Conversely, in young women desiring pregnancy, the polyp is removed electively under visual control, taking all precautions to preserve fertility.
    • After the procedure, all removed elements are analyzed in the lab to ensure that the polyps are indeed benign.

    WHAT ARE THE RISKS OF OPERATIVE HYSTEROSCOPY?
    Like any surgical procedure, operative hysteroscopy carries risks, but they are rare:

    • Uterine perforation;
    • Infection of the uterine cavity (endometritis);
    • Hemorrhage;
    • Anesthesia-related risks (general or epidural anesthesia).

    In summary:
    A polyp is a benign uterine lesion that can be discovered incidentally or due to bleeding and requires removal by operative hysteroscopy for histological analysis.