This weekend, a middle-aged aunt in a hurry came to the gynecological clinic, and as soon as she entered the clinic, she poured bitter water on the doctor. It turned out that since the aunt found endometrial polyps in the unit 3 months ago, this was the second time to review. The aunt searched on the Internet and said that the polyps may be malignant lesions and were very afraid.
But surprisingly, this examination, B ultrasound did not prompt the uterine cavity occupancy, the endometrial polyp magically disappeared. At the same time as the aunt was surprised, she also had some doubts: where did the endometrial polyps go?
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Endometrial polyps are a common disease in gynecology, caused by excessive endometrial hyperplasia, and the cause and pathogenesis are still unclear. Existing scholars believe that its incidence is closely related to high estrogen levels, decreased progesterone receptors, chronic inflammation, and abnormal expression of proto-oncogenes. Endometrial polyps can be found at all ages, but the most common is between 40-50 years of age.
Endometrial polyps do have the potential to resolve on their own
In fact, it is true that about 25% of endometrial polyps may disappear on their own, and the smaller the easier it is to disappear, especially less than 10 mm, it is likely to disappear with the peeling of the endometrium after several menstrual periods.
Scratch the point, is small polyps, especially smaller than 10 mm.
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There is also a possibility that it is related to the diagnosis. The main tool for the initial clinical diagnosis of endometrial polyps is yin ultrasound. It has been reported that the sensitivity of yin ultrasound to the diagnosis of endometrial polyps is 19% to 96%, and the specificity is 53% to 100%. Sometimes, the thickened lining of the luteal phase may be mistaken for endometrial polyps. Therefore, it is very likely that after menstruation, I will do b ultrasound and find that the polyps have "disappeared". Therefore, it is also recommended that you try to do B ultrasound on the 5th-7th day of menstruation, that is, when the inner membrane is thinnest when menstruation is just clean, and the results will be more accurate.
Do polyps change all the time?
Endometrial polyps may subside, but there are also a small part of the polyps that may be malignant. It has been reported that about 0% to 12.9% of endometrial polyps may have malignant changes. The most common cancer subtypes are endometrioid adenocarcinoma and serous adenocarcinoma.
Possible risk factors for endometrial polyp malversion include advanced age, obesity, hypertension, polyp size (> 15 mm), and use of hormone replacement therapy. Endometrial polyps with postmenopausal bleeding are at highest risk of malignancy. Postmenopausal bleeding women have been reported to have a reported risk of malignant polyps up to 6%.
What should I do if I have an endometrial polyp?
For intimal polyps with no obvious symptoms, no high-risk factors, and small volume, they can be temporarily unintermediated and followed up regularly.
However, surgery is recommended for those with obvious clinical symptoms, such as postmenopausal bleeding, those with high risk factors, and those affecting pregnancy.
There are several surgical modalities for the treatment of endometrial polyps. Among them, hysteroscopic endometrial polypectomy is the most important treatment method, which can simultaneously determine the size and position of the polyp and perform precise resection.
bibliography
1、Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019 May 2;7:2050312119848247. doi: 10.1177/2050312119848247. PMID: 31105939; PMCID: PMC6501471.
2、Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 2011 Sep-Oct;18(5):569-81. doi: 10.1016/j.jmig.2011.05.018. Epub 2011 Jul 23. PMID: 21783430.
3、Vroom AJ, Timmermans A, Bongers MY, van den Heuvel ER, Geomini PMAJ, van Hanegem N. Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019 Jul;54(1):28-34. doi: 10.1002/uog.20229. Epub 2019 Jun 12. PMID: 30693579.
Shanghai Municipal Science and Technology Commission Science Popularization Project Grant (Project No.: 20DZ2311000)
Review: Chen Yisong, Lu Zhiying
Editor: Li Miaoran