The polyps of the mucous membrane of the cervical canal are among the most common diseases and are in first place among all benign pathological processes of the cervix. According to statistics, cervical polyp is found in one in five women seeking an appointment with a gynecologist.

What is a cervical polyp?

Cervical polyp - a tumor formation, which grows from the wall of the cervical canal into the lumen. Polyps may be single or multiple (polyposis cervical canal). Polyps may develop in the external os, at the junction of epithelium (stratified squamous and cylindrical), in the middle or upper part of the endocervical. Typically, polyps of the cervical canal located on foot. By lengthening the legs polyps, localized in the middle or upper part of the mucous membrane of the cervical canal may reach the level of the external os or act beyond it. But sometimes polyps are not leg and wide base. According to histological classification distinguished:

• glandular polyps;
• glandular-fibrous polyps;
• adenomatous polyps (prone to malignancy);
• angiomatous;
• epidermiziruyuschy.

The causes of polyps

The causes of polyps is still not well understood. There have been suggestions that the polyps develop as a result of the following processes:

• hormonal disorders of the reproductive system;
• chronic pelvic inflammatory disease;
• the effects of trauma cervix (tears during childbirth, abortion, hysteroscopy).

Clinical manifestations of cervical polyp

Most polyps are often observed in women over forty years. Normally, cervical polyps are asymptomatic. Complaints and objective manifestations of the polyp is usually dependent on the concomitant diseases of the sexual sphere. May experience spotting Spotting - it is important to rule out pathology   after intercourse (contact bleeding) or as a result of injuries, circulatory disorders in the formation or ulceration. Some patients complain of nagging pain in the abdomen Abdominal pain: when to sound the alarm? , Menstrual dysfunction, and infertility. Infertility is not typical and is caused by a concomitant symptom and a cause because of which formed cervical polyp.

During the inspection of the cervix in the mirrors is determined by the bright red of the cervical canal, a maximum of seven - ten millimeters. Cervical polyps has a smooth surface and rounded shape. Sometimes polyps can occur secondary changes associated with inflammation (due to injury and subsequent infection). In case of violation of circulation in the new formation of the polyp becomes a crimson or purple. Hypertrophied cervix is ​​increased and cyanotic. During palpation of the polyp is determined by its consistency. Glandular polyps soft to the touch, and fibrotic (with a predominance of connective tissue) tightly-elastic.

During pregnancy in the stromal cells of the polyp may occur changes similar to decidual changes in the endometrium, the so-called decidual polyps.

Diagnosis of cervical polyp

Diagnosis of cervical polyps is not difficult. Highlights of the survey:

• inspection of the cervix in the mirrors;
• colposcopy Colposcopy - how to prepare it properly?   and cervicoscopy;
• hysteroscopy;
• histological examination of the mucous membrane of the cervical canal.

Treatment of cervical polyp

Treatment of cervical polyp is aimed at removing it. Exceptions are polyps that have appeared during pregnancy (they usually disappear on their own after birth). Before removing the polyp prescribe anti-inflammatory and antibacterial therapy. Polyps are removed by loosening and then treated bed polyp electrocoagulation or cryodestruction (liquid nitrogen). If a polyp is located near the external os, his leg wedge excised, and then applied to the wound surface catgut suture. In the case of the location of the polyp deep into the cervical canal, the removal of its produce under the control hysteroscopy. In order oncological alertness after the removal of polyps is recommended that a separate diagnostic curettage Scraping - heavy and unsafe procedure   cervix and uterus.

Anna Sozinova

Drug treatment of uterine adenomyosis typically prescribed for mild forms of adenomyosis, and women who plan to have future children.

Levonorgestrel-releasing IUD

One of the most common types of medical treatment of uterine adenomyosis is the use levonorgestrel-containing intrauterine devices, such as Mirena. One study examined the effects of long-term clinical use of intrauterine devices. The researchers evaluated the condition of patients in several indicators (degree of tissue damage, the severity of symptoms such as dysmenorrhea and menorrhagia) before installing the IUD, and 36 months after it was installed. Patients noted that more than 6 months after the installation of a spiral of pain during menstruation became much weaker. Three years later, almost all of the symptoms of adenomyosis Adenomyosis: Symptoms - what to expect from the body?   either disappeared or have become considerably less pronounced.

In another study, doctors in three years watching the 94 women who for the treatment of uterine adenomyosis established levonorgestrel-releasing intrauterine devices. Before treatment all patients experienced moderate or severe dysmenorrhea. In the course held in six and twelve months of examination the doctor noted a significant improvement in the subjects.

Danazol-content intrauterine devices

Recently in Japan developed danazol-containing intra-uterine devices, which are, in fact, IUDs, coated with silicone rubber containing 300-400 mg of danazol. Externally, the device is very similar to conventional intrauterine device, but it is much thicker rod. Because of this feature, danazol-containing intrauterine devices for proper installation may need cervical dilatation.

During clinical trials of these devices danazol levels in the blood of the subjects remained below the detection threshold, so it is believed that their use does not cause side effects associated with oral administration of danazol.

After clinical trials have been completed, the danazol-containing intra-uterine devices were tested on 14 women who called adenomyosis, dysmenorrhea, menorrhagia Menorrhagia (menorrhagia) - excessive blood loss   and infertility. After a few months in 12 patients completely disappeared menorrhagia and significant relief of dysmenorrhea occurred in 9 patients. Only two women's use of danazol-containing intrauterine devices to no avail.

In another study, involving 21 women with adenomyosis, for 6 months 81% of patients completely got rid of menstrual pain. Menstrual bleeding normalized in 76% of subjects. There was no single case of occurrence of the known side effects of danazol.

The only disadvantage of danazol-containing intrauterine devices, which have been noted in the course of investigations, was short-lived smearing bleeding.

New treatments

Available treatments adenomyosis are far from ideal, so experts are constantly looking for new ways in which it would be possible to treat this violation more safely and effectively.

• Aromatase inhibitors

Adenomyosis as endometriosis, is considered to be estrogen dependent diseases. One of the most important steps to a better understanding of the disease was the discovery that women with adenomyosis as the eutopic and ectopic endometrium express the enzyme that converts androgens into estrogens - P450 aromatase. Presumably, this phenomenon is observed only in women with reproductive system diseases such as endometriosis, uterine fibroids and adenomyosis.

If adenomyosis develops under the influence of estrogen, the only effective treatment for its operation is the complete removal of the affected tissue adenomyosis - otherwise the disease will continue to progress. In practice, it cuts out all the diseased tissue is extremely difficult.

An alternative method of treatment, scientists believe the use of substances that can inhibit the biosynthesis of estrogen locally Estrogen - the key to bone health   (aromatase inhibitors), along with GnRH agonists. This will help to significantly reduce the risk of re-development of adenomyosis after conservative surgery.

This assumption was confirmed by the results of the study, in which patients with endometriosis after surgery assigned to receive an aromatase inhibitor - anastrozole and GnRH agonist - goserelin. For the subjects were followed for 24 months after surgery. It turned out that those who took the drugs, the probability of relapse is significantly lower than in patients who took a placebo Placebo - an effective tool for self-hypnosis . Scientists believe that this method of treatment is as effective for women with adenomyosis. It is expected that in the near future it will be widely used for the treatment of severe endometriosis and adenomyosis in women of reproductive age.

• Angiogenesis inhibitors

The researchers found that the walls of the uterine tissue in the adenomyosis and endometriosis process of angiogenesis (formation of new blood vessels in tissues) begins to change. This discovery prompted the idea of ​​the possibility of using for the treatment of adenomyosis angiogenesis inhibitors. In the course of experiments on animals it has been found that cabergoline leads to slower tumor growth in adenomyosis and endometriosis, and also blocks the formation of new blood vessels in diseased tissue. There will be more research to understand how this medication may affect humans.