Uterine fibroids, also known as myomas or leiomyomas, are benign (non-cancerous) growths that develop in the uterus. They are the most common type of growth found in the female pelvis (the area of the lower abdomen and groin). They are present in approximately 25-50% of all women. Many women with fibroids may be unaware of their presence as they can remain small and asymptomatic. However, in some women, fibroids can cause problems due to their size, number, or location.
Fibroids often do not cause any symptoms and are discovered incidentally during routine gynecological examinations. However, they can sometimes cause the following symptoms, which may be proportional to their size:
The development of fibroids is closely related to hormonal changes in the body. For example, fibroids often shrink after entering menopause when hormone levels decrease. While estrogen has been primarily implicated in fibroid development, recent studies have also shown the influence of progesterone. Exercise and smoking are believed to be factors that can reduce the development of fibroids. Birth control pills may have a protective effect against fibroid development.
Most fibroids, especially small ones that are asymptomatic, do not require treatment. However, fibroids that cause significant symptoms, affect fertility, or have the potential to be malignant or resemble cancerous tumors require treatment. If the fibroid is small, regular follow-up examinations every six months are recommended to monitor its growth. Treatment typically involves surgical intervention, as there is currently no highly effective medical treatment available.
Myomectomy involves the surgical removal of fibroids from the uterus. It can be performed using laparoscopic or open surgical techniques. It is a preferred approach for women who desire future pregnancies as it preserves the uterus. However, the recurrence rate of fibroids after myomectomy is approximately 50-60% within five years, and in about a quarter of cases (10-15%), a repeat surgery is necessary.
Hysterectomy, the surgical removal of the uterus, is a treatment option for women with rapidly growing fibroids causing significant symptoms or for those who do not plan to have future pregnancies. In some cases, the ovaries may be preserved to prevent menopause.
While surgery is the most commonly used treatment for fibroids, ongoing research and studies are providing insights into new treatment modalities. These include procedures such as uterine artery embolization, uterine artery occlusion, and myolysis.
Endometrial polyps originate from the endometrium, the lining of the uterus. Certain areas of this tissue may overgrow and protrude into the uterine cavity, forming polyps. These polyps remain connected to the endometrium. If the connection is thin, they are called pedunculated polyps. In some cases, the connection between the endometrium and polyp spreads over a larger area, resulting in broad-based polyps.
The exact cause of endometrial polyps is unknown. However, it is believed that excessive estrogen activity may contribute to their development, as they are often associated with endometrial hyperplasia. Women taking tamoxifen for breast cancer treatment are also more likely to develop endometrial polyps.
It is challenging to provide an exact prevalence rate for endometrial polyps, but they are commonly observed. Some studies suggest that polyps are found in approximately 50% of women, while the general consensus is around 10%. They can occur in women of all ages, but are most frequently seen in the age group of 39-50.
Polyps are classified into different groups based on their shape and functional characteristics:
Hyperplastic polyps: These are estrogen-dependent and exhibit characteristics similar to endometrial hyperplasia.
Functional polyps: These polyps contain glandular cells similar to the surrounding endometrium.
Adenomatous polyps: These polyps also contain some muscle tissue.
Atrophic polyps: These are the result of atrophy, where hyperplastic or functional polyps shrink over time.
Pseudopolyps: These are small structures, typically less than 1 centimeter, that appear during the second phase of the menstrual cycle and disappear with menstrual bleeding.
Most endometrial polyps are asymptomatic and are incidentally discovered during other examinations or after uterine procedures. The most common symptom is abnormal uterine bleeding, such as heavy or prolonged periods or spotting between periods. In some cases, a brown discharge may occur following menstruation.
While the relationship between endometrial polyps and infertility or recurrent miscarriages is still debated, it is generally accepted that they can contribute to infertility. When an embryo implants on a polyp, normal development may be compromised. Even when a polyp is located outside the endometrial area, it can obstruct the uterus and interfere with a healthy pregnancy. One study reported that approximately 24% of couples experiencing infertility had endometrial polyps.
The likelihood of endometrial polyps becoming cancerous is extremely low.
Various methods can be used to diagnose endometrial polyps. The most common diagnostic tool is transvaginal ultrasound, although it can sometimes be challenging to differentiate between polyps and other structures. Saline infusion sonohysterography (SIS), which provides better visualization of the uterine cavity, is considered one of the most effective methods for polyp diagnosis. SIS has a sensitivity of 100%, while transvaginal ultrasound has a sensitivity of 66% for detecting polyps.
Hysteroscopy is considered the gold standard for diagnosing endometrial polyps. It allows