How to treat uterine polyps

Of course, endometrial polyps must be treated actively. They are mainly caused by excessive growth of the local endometrium of the uterus. The sizes of polyps vary, and we must know the high-risk factors for the formation of endometrial polyps. If they continue to exist, then even after surgical removal, there may be a risk of recurrence. Therefore, the choice of treatment method must be based on the doctor's examination and treatment decision.

1. Endometrial polyps are caused by excessive growth of the local endometrium of the uterus, which is composed of glands, stroma and blood vessels. Polyps can vary in size, be multiple or single, and have or without pedicles. Increasing age, hypertension, obesity, diabetes, perimenopausal and postmenopausal hormone replacement therapy, and long-term use of tamoxifen after breast cancer surgery are not only high-risk factors for endometrial polyps, but also high-risk factors for atypical hyperplasia and malignant transformation of endometrial polyps. The malignant transformation rate of endometrial polyps is not high, ranging from 0 to 12.9%. Endometrial polyps can be found in 10 to 40% of premenopausal abnormal uterine bleeding. However, the rate of malignant transformation is not high. However, with the increase of age, especially in postmenopausal patients with irregular vaginal bleeding, the chance of malignant transformation of endometrial polyps increases. In addition, endometriosis and adenomyosis are also common factors for the formation of endometrial polyps.

2. If these high-risk factors for the formation of endometrial polyps continue to exist, there is still a risk of recurrence even with hysteroscopic resection, with a postoperative recurrence rate of 2.5%-3.7% (a literature with a 9-year follow-up). To avoid the recurrence of endometrial polyps, patients who have no fertility requirements, abnormal menstruation, or heavy menstrual flow can choose to use a contraceptive ring containing progesterone - the Mirena ring. After the ring is inserted, the progesterone inhibits endometrial hyperplasia, and the recurrence rate of endometrial polyps may decrease. Oral contraceptives and progestins also have a certain inhibitory effect on the occurrence and development of endometrial polyps. Total hysterectomy for endometrial polyps in postmenopausal women with symptoms is a radical cure with no possibility of polyp recurrence or malignant transformation, but it is a relatively traumatic surgery and is not recommended if there is no atypical endometrial hyperplasia.

3. Can endometrial polyps be treated conservatively? 25%-27% of endometrial polyps can resolve on their own within one year, especially those with a diameter less than 25px, which can be treated conservatively. The effect of drug treatment is limited. The application of GNRHa before hysteroscopy can thin the endometrium and stop bleeding, which is beneficial to the operation. However, discontinuation of the drug will lead to recurrence. The drug is expensive and has side effects. Therefore, drug treatment for endometrial polyps is not currently recommended. Small asymptomatic polyps after menopause are unlikely to become malignant and can be observed.