Patient's question:
The menstrual cycle is normal, the color is bright, no blood clots, and it takes 8 days to clean up. During the second menstrual period, there was bleeding in the middle of the cycle for about 5 days. An endoscopic examination revealed polyps in the endometrium, and a D&C procedure showed simple hyperplasia in the pathology. Then, during a follow-up examination, polyps were still found. What should I do?Doctor's answer:
Hello:Different treatment methods are adopted based on the size, location, morphology of the endometrial polyps, and the patient's age.
1. For larger polyps with stalks located in the cervical canal or outside the cervix, visible or palpable, they can be removed via cervical excision, followed by cervical and uterine cavity curettage to remove the remaining polyps.
2. For small or diffuse polyps, hysteroscopic curettage is performed, with thorough scraping, especially at the fundus and uterine cornua. This is because small, isolated stalked polyps located at the fundus are easily overlooked.
3. For patients over 40 years of age with frequent polyp recurrence and bleeding, and obvious symptoms, hysteroscopic resection of the endometrial cavity or total hysterectomy can be performed.
4. The polyps and all scraped tissues should undergo pathological examination to check for malignancy. If the pathology reveals that the polyps originate from mature endometrium, androgen therapy can be used to counteract the effects of excessive estrogen, or progesterone therapy can be used to transform the endometrium and prevent recurrence. If the polyps originate from immature endometrium, hysteroscopic polypectomy should be performed, especially for complex hyperplasia or atypical hyperplasia polyps, which should undergo hysterectomy.
Postmenopausal polyps differ from general postmenopausal endometrium and are less likely to shrink with the decline of ovarian function. They often show varying degrees of hyperplasia. Guo (1991) reported that 70% of postmenopausal polyps exhibited hyperplastic features, with the ratio of cystic adenomatous hyperplasia polyps being similar to that of premenopausal individuals.
Regarding the occurrence of endometrial polyps, recent studies suggest that they are caused by the uterus