Hysteroscopic removal of endometrial polyps
Modern gynecology considers the most optimal method to remove polyps using hysteroscopy.
How is a polyp removed?
The gynecologist first examines the patient, then the doctor inserts a thin probe of the hysteroscope into the uterine cavity. This manipulation makes it possible to assess the features of the endometrium, remove the polyp under the optical control of the equipment, take samples of the inner layer and the polyp itself for histology.
The day of the cycle does not affect this procedure. However, the most informative analysis can be carried out on the 4th-6th day of the menstrual cycle, immediately after the end of menstruation. In the period preceding menstruation, the heterogeneous structure of the endometrium complicates this procedure.
Small polyps are removed on an outpatient basis, with minimal pain relief, since this intervention does not bring significant pain. According to the reviews of women who underwent hysteroscopy along with the removal of the polyp, the pain during this procedure is practically no different from the sensations during menstruation.
One hour before the intervention in the uterine cavity, it is advisable to take one tablet of an analgesic or NSAID (ibuprofen in a dosage of 400 to 600 mg). Large polyps are removed under short-term general intravenous anesthesia.
Methods for removing polyps:
- Surgical scissors;
- Using a laser knife;
- Electrocautery.
The choice of the most effective method for destruction of the polyp in each case is at the discretion of the gynecologist.
Recommendations after removal of the polyp
Possible symptoms after hysteroscopy with polypectomy:
- Minor pain in the pelvic area and perineum;
- Small amount of bloody or mucous vaginal discharge.
These manifestations do not require treatment; women with a high pain threshold can take pain relievers.
To prevent complications after the intervention, women should refrain from:
- From the use of hygienic tampons (pads are allowed);
- From douching;
- From sexual activity;
- From physical stress and hypothermia;
- From taking a bath, visiting a sauna, bath, swimming pool, swimming in the sea (it is allowed to take a shower).
What is known about the effectiveness and safety of removing uterine polyps using hysteroscopy?
Removal of an endometrial polyp with the help and control of a hysteroscope is a safe procedure with minimal complications. Possible negative feelings during its implementation:
- Nausea;
- Lower abdominal pain;
- Fainting during or after the procedure is extremely rare.
Scanty spotting after removal of the polyp is a variant of the norm. They are not dangerous, do not require treatment, last several days, and pass on their own.
The development of the inflammatory process after hysteroscopy is diagnosed in no more than one woman in a hundred. The introduction of infection into the female body is treated with antibiotics.
An extremely rare complication of surgery is perforation of the uterus, accompanied by damage to nearby organs. In this case, an emergency, rather complex surgical operation is performed.
As a result of medical research, it has been established that the polyp appears again after removal under the control of a hysteroscope in only a small number of cases. For 9 years after the procedure, this probability ranges from 2.5% to 3.7%.
This method is especially effective in the treatment of abnormal vaginal discharge. The study of this problem proves the feasibility of the method of hysteroscopic removal of endometrial polyps for the complete elimination or significant relief of symptoms in 75-100% of patients. If this method did not affect the problem of abnormal discharge, the cause should be sought in the course of additional examination.
Women with a high risk of developing endometrial hyperplasia or the threat of its oncological degeneration can receive a detailed histological analysis of tissues after removal of the polyp.
The adhesion process almost never becomes a complication of hysteroscopy, since this procedure does not affect the muscular layer of the uterus.
If the presence of a polyp was a suspected cause of infertility, then attempts to conceive a child or start performing an IVF protocol can be done with the onset of menstruation after the procedure.
According to medical statistics, in 43-80% of cases of infertility caused by polyps of the uterus and its cervix, pregnancy occurred after hysteroscopic removal of endometrial polyps. Conception was carried out naturally or with the help of in vitro fertilization. Artificial injection of sperm into the uterus after polypectomy was successful in 65% of cases.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
