Gynaecologic Problems: Polyps

Endometrial polyps

Description

Endometrial polyps are localised overgrowths of the endometrium that project into the uterine cavity. Such polyps may be sessile (broad-based) or pedunculated (on a narrow stalk) and rarely include areas of neoplastic (benign or malignant) growth. Specifically, adenomatous hyperplasia (benign growth of the endometrium) and endometrial adenocarcinomas (malignant tumours of the glandular component of the endometrium), have been reported in only 0.6% of cases of endometrial polyps.
The prevalence of polyps is estimated to be 10% to 24% of women undergoing hysterectomy (surgical removal of the uterus) or localised endometrial biopsy . Endometrial polyps are rare among women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age, peaking in the fifth decade of life, and gradually declines after menopause .

Symptoms and Signs

The most frequent symptom of women with endometrial polyps is metrorrhagia , which is reported in 50% of symptomatic cases. Post-menstrual spotting is also common. Less frequent symptoms include hypermenorrhea , post-menopausal bleeding, and breakthrough bleeding during hormonal therapy.
Overall, endometrial polyps account for 25% of abnormal bleeding in both premenopausal and postmenopausal women. Endometrial polyps are often diagnosed by microscopic examination of a specimen obtained after endometrial biopsy or after D&C .

Diagnosis and Treatment

As with submucous fibroids, the diagnosis of polyps can be missed on physical exam if the uterus is not distended. Therefore, these lesions are being increasingly diagnosed by techniques such as ultrasound and hysteroscopy .
The majority of cases of endometrial polyps are cured by thorough curettage. This technique, which involves removing the endometrial lining of the uterus, is especially successful in the post-menopausal age group. However, removal of polyps or other structural abnormalities may be missed by blind curettage, therefore, hysteroscopic-guided curettage is often useful (see also D&C ). [ 1 ]

Cervical polyps

Description

Cervical polyps are projectile growths originating from the mucosal surface of the cervix or endocervical canal. These small, fragile growths hang from a stalk and protrude through the cervical opening. The cause of cervical polyps is not completely understood, but they are frequently the result of infection. They may be associated with chronic inflammation, an abnormal local response to increased levels of oestrogen, or local congestion of cervical blood vessels. Cervical polyps are relatively common, especially in women over 20 years who have had children. Only a single polyp is present in most cases but sometimes 2 or 3 are found. They are rare before menarche . Cervical polyps

Symptoms and Signs

Symptoms and Signs include the following:

• Abnormal vaginal bleeding : after intercourse (postcoital), after douching, between periods, after menopause.
• Menorrhagia .
• White or yellow mucous discharge ( leukorrhea ).

Diagnosis and Treatment

A pelvic examination reveals smooth, red or purple, finger-like projections from the cervical canal. A cervical biopsy typically reveals mildly atypical cells and signs of infection.
Treatment involves the removal of the polyps. Removal is typically done as a simple, outpatient procedure. Gentle twisting of a cervical polyp is frequently enough to remove it, however, normally one is removed by tying a surgical ligature around the base and cutting it off. Removal of the base is done by electrocautery or laser vaporisation. Because many polyps are infected, an antibiotic may be administered after the removal, either prophylactically or with any early signs of infection. Although most cervical polyps are benign, the excised tissue should be sent to a pathologist for microscopic examination.
Typically, polyps are benign and easily removed. Regrowth of polyps is uncommon.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Center for Uterine Fibroids: http://www.fibroids.net/
2. Medline Plus Medical Encyclopaedia, U.S. National Library of Medicine: http://medlineplus.gov