ENDOMETRIAL AND CERVICAL POLYPS (Part two)

Prognosis

• Most endometrial polyps are benign in nature and few of them are malignant.
• They increase the risk for missed abortion in women with IVF.
• Small polyps regress spontaneously.
• They have frequent recurrences.
• If the polyps are located near the fallopian tubes, they lead to difficulty in getting pregnant.

Treatment

1. Curettage with or without hysteroscopy
   Initially, forceps are used to detach the polyp and then curettage of the uterine cavity is performed in order to completely clean it.
2. Hysteroscopy
   One of the most important examinations that gives us the opportunity to conduct a complete check of the entire uterine cavity and then to proceed with the removal of the polyp and its peduncle. The removed material is sent for biopsy. If malignancy is suspected, material from the suspicious areas is taken with hysteroscopy and its histopathological evaluation is performed.

CERVICAL POLYP

General

1. The cervical polyp is a benign tumor that grows on the surface of the cervical canal, it is a smooth growth, red in color, and finger-shaped.
2. They are more common in premenopause and postmenopause.
3. About 99% of them are benign in nature and 1% of them are malignant.
4. They are more often found in women over the age of 20 and in women who have had multiple pregnancies.

Cause

The cause is unknown, however, it is often associated with an inflammation of the cervix and an abnormal response to elevated levels of circulating estrogens. Natural variations of estrogens occur during life, especially during pregnancy, the menstrual cycle, or in the first months after menopause. For example, during pregnancy, estrogen levels can reach up to 100 times the normal values.

Chronic inflammation (the most common causes are: bacterial infections, HPV, herpes)

Congestion of blood vessels in the cervical canal.

Classification

1. Endocervical polyp (more common in premenopausal women, the polyp develops within the cervical canal)
2. Exocervical polyp (more common in postmenopausal women, the polyp develops outside the cervical canal)

Symptoms

1. Asymptomatic
2. Intermenstrual bleeding
3. Menorrhagia
4. Postmenopausal bleeding
5. Leukorrhea
6. Increased vaginal discharge, yellow or white mucus
7. Bleeding after contact

Some of the above signs may also be signs of cervical cancer. In rare cases, the polyp may be the initial sign of a precancerous condition of the cervical canal. Removal and histopathological evaluation of the polyp is necessary to exclude such conditions.

Diagnosis

• Established during a routine vaginal examination or for bleeding.
• Pap test
• Cervical biopsy

Treatment

• The removal of the polyp is performed with forceps and the removal of the polyp base is performed with laser or cauterization.
• If infection occurs, antibiotic treatment is also given
• During and after the procedure, acetaminophen or ibuprofen is used to alleviate discomfort or cramps.
• The removal of the polyp is a simple procedure that is performed on an outpatient basis, safe and non-invasive. It is necessary to have regular pelvic examinations and Pap tests in order to assess the possibility of polyp reformation and abnormal cervical cell conditions.