home Adviсe Removal of the polyp and endometrium recovery period. Hysteroscopy of a uterine polyp - the course of the operation. The main questions that arise in the long-term period after polyp removal

Removal of the polyp and endometrium recovery period. Hysteroscopy of a uterine polyp - the course of the operation. The main questions that arise in the long-term period after polyp removal

It is rarely accompanied by significant tissue trauma, so in the vast majority of cases, physical activity will be allowed shortly after surgery. Moreover, doctors often even recommend certain physical exercise for preventive purposes. It all depends on how exactly the operation was performed and how the body’s recovery proceeds.

Physical activity after removal of uterine polyps is not recommended in the following cases:
1. high level of trauma during surgery;
2. presence of signs of complications;
3. antibiotic therapy or hormone therapy.

High traumatism during surgery.

If uterine polyps were removed by curettage ( scraping the walls of the uterus) then after the operation it is necessary to for a long time for complete healing of wounds. Physical activity, increasing intra-abdominal pressure, compress the uterus, bending its walls. This can lead to complications such as uterine bleeding or severe pain. In any case, physical activity in the first 3 to 4 weeks after curettage will disrupt the process of tissue regeneration and slow down recovery. Less traumatic in this regard is hysteroscopic removal of polyps. It is not accompanied by large-scale damage to the healthy mucous membrane of the uterus. Physical activity, in the absence of complications, can be given already 2–3 weeks after surgical intervention.

Presence of signs of complications.

It is recommended to refrain from physical activity, if available obvious signs any postoperative complications. In these cases, stress can aggravate the situation and pose a threat to the patient's health.

You need to limit your loads if the following symptoms appear:

bloody or mucous vaginal discharge;
temperature more than 37 degrees;

All these signs indicate that the wounds after the removal of polyps have not yet healed and the body has not yet returned to normal. Excessive physical activity in this case will be a burden to him and will slow down the recovery process.

Antibiotic therapy and hormonal therapy.

In some cases, after removal of uterine polyps, a course of antibiotics or hormonal drugs may be prescribed. This is necessary to prevent relapse ( re-formation of polyps) and elimination of certain disorders and diseases. Taking antibiotics or hormones puts additional stress on the liver, kidneys, and also affects heart function and muscle strength. As a result, heavy physical activity may be poorly tolerated and lead to the emergence of new diseases.

The preventive effect of physical activity is observed in cases where the patient is at risk of the formation of adhesions inside the uterus. This complication occurs quite often during curettage, or if cauterization was not performed when removing the polyp. Adhesions in the uterine cavity can lead to infertility, chronic pain and other disorders. In order not to harm the body and obtain maximum preventive benefits, you need to pay attention to the nature of physical activity.

For preventive purposes, to reduce the risk of adhesions, it is recommended the following types loads:

Swimming. Swimming helps relax muscles, and at the same time stimulates the movement of the internal walls of organs. This will prevent the formation of adhesions in the uterus with minimal risk to the patient. You can start swimming lessons no earlier than 3 weeks after removal of polyps, in the absence of postoperative purulent complications.
Hiking on fresh air. Walking in the fresh air improves overall immunity and stimulates regenerative processes in the body. It is recommended to walk for 30–40 minutes a day 2–3 days after surgery.
Easy running. Light running also helps work the abdominal muscles and prevents the formation of adhesions. Classes can begin 2 weeks after removal of polyps.
Physiotherapy. Therapeutic gymnastics is a set of exercises specifically aimed at reducing the risk of adhesions. There is practically no threat of any complications, since the exercises are selected individually by a specialist, taking into account the woman’s general condition.

In general, the nature and intensity of physical activity should be discussed with your doctor, since only he has all the information about each specific case of the disease. You should also not forget about preventive examinations after surgery, because excessively intense stress can provoke any complications.

For women of reproductive age, the appearance of growths on internal walls uterus becomes a collapse of hope, especially if there are problems with conception. Correctly performed surgery to remove a polyp gives a chance to give birth to a healthy child. Why do growths appear on the endometrium, how to deal with them? It is useful for women to know the features of surgical intervention, the chances of recovery, possible complications.

What is a polyp in the uterus

Under influence inflammatory processes, hormonal disorders and many other reasons, a woman may develop endometrial hyperplasia in her uterus. Overgrowth of the mucous membranes leads to the formation of polyps. These formations are safe for life, but can provoke:

chronic disruptions of the menstrual cycle;
infertility;
complicated pregnancy;
miscarriage;
development of malignant neoplasm.

A polyp in the uterine cavity has its own characteristics. The formation is found solitary or in the form of numerous processes. The shape is round or mushroom-shaped, has a thick base or a thin stalk, with a color from light pink to burgundy. Based on histological characteristics, types of endometrial tumors are distinguished, which are formed from:

connective tissues – fibrous;
glandular cells– glandular;
combinations of two varieties - fibroglandular;
tissues with atypical cells - adenomatous, developing into cancer;
the remains of the placenta after childbirth are placental.

A small polyp in the uterus has no symptoms. Expressed symptoms pathologies appear with large sizes or polyposis - multiple formations. Surgery is necessary if women experience:

uterine bleeding;
vaginal discharge Brown in the middle of the menstrual cycle;
pain in the lower abdomen and lumbar region;
discomfort and bleeding during sexual intercourse;
heavy and painful periods;
problems of conception;
emergence iron deficiency anemia;
discharge of mucous leucorrhoea from the vagina;
miscarriages.

Why do polyps appear?

One of the main reasons for the development of formations in the uterine cavity is hormonal disorders associated with excess estrogen and lack of progesterone. This situation is caused by endocrine and neuropsychiatric disorders. Provoking factors for the occurrence of polyps are:

A polyp on the uterus can form as a result of such gynecological pathologies:

Removal of polyps

Treatment of uterine tumors begins with conservative therapy. Removal of a polyp in the uterus is carried out if indicated. These include:

lack of results from drug treatment;
brown discharge With unpleasant smell;
pain, discomfort during sexual intercourse;
scanty discharge during menstruation or lack thereof;
infertility;
severe uterine bleeding;
miscarriages;
heavy and prolonged menstruation;
age over 40 years;
polyp size more than 10 mm;
identification of atypical cells that provoke cancer.

Surgery to remove a polyp in the uterus is performed using several methods:

hysteroscopy - elimination of the formation by twisting its legs using special equipment;
diagnostic gynecological curettage– curettage – removal of the top layer of mucosa using a curette;
burning laser beam;
radiosurgical excision;
cryodestruction with liquid nitrogen.

How to remove a polyp in the uterus without surgery

If a woman is contraindicated for surgical intervention or is opposed to this method of treatment, doctors carry out conservative drug therapy. Several groups of drugs are used depending on the age, condition of the patient, and symptoms. Gynecologists prescribe combined oral contraceptives Regulon, Yarina, which:

reduce the size of polyps, promote their removal;
used for nulliparous women from 18 to 35 years old;
used when the polyp size is less than 10 mm;
give results if available uterine bleeding.

Treatment without removing the polyp is carried out using medicines:

Duphaston, Utrozhestan - gestagens with active substance progesterone – normalize functions endocrine system, improve blood condition;
Diferelin, Zoladex - gonadotropin releasing hormones - are prescribed for menopause, women over 35 years of age, for focal and total endometrial hyperplasia.

If it is possible not to perform the operation, gynecologists prescribe medications:

antibiotics - Monomycin, Zitrolide, Doxycycline, if the cause of polyp formation is genital infections, inflammation in the pelvic area;
iron preparations Ferlatum, Fenyuls - for anemia caused by blood loss;
vitamin complexes to maintain body tone;
homeopathic remedies for natural basis- require long-term use according to the scheme.

Laser removal

For women of childbearing age, this is the most safe method treatment that preserves reproductive function. Unfortunately, due to high cost Not all clinics have laser equipment. Removing a polyp in the uterus using this method has the following advantages:

low risk of bleeding - the vessels are cauterized by the high temperature of the beam;
greater accuracy of operation;
there is no injury to neighboring tissues;
minimal risk infections;
scars and adhesions do not appear;
short recovery period;
layer-by-layer elimination of the polyp results in fewer relapses.

Surgery to remove an endometrial polyp using a laser is performed 7 days after the start of the menstrual cycle, when the endometrium is thin and the formation is clearly visible. The duration of the intervention is from 10 minutes to one and a half hours, depending on the size of the growth. The rehabilitation period is up to 8 months. Before starting manipulations:

two hours before surgery, the uterine cavity is filled with an antiseptic to prevent infection;
A hysteroscope is inserted through the vagina - optical instrument to monitor the progress of the operation on the screen.

Surgical intervention occurs according to the following scheme:

Based on the results of preliminary diagnostics using ultrasound, a surgical plan is drawn up;
In accordance with the size of the polyps, the power of the installation is adjusted; for small sizes, the tissues are evaporated; for large ones, the laser action occurs in layers;
local anesthesia is performed in the area of the tumor;
the polyp is removed;
Cauterization of blood vessels is performed to stop internal bleeding.

Hysteroscopy

Removing endometrial growths with this method is considered minimally invasive. Hysteroscopy is recommended to be performed no later than the tenth day after menstruation. Features of surgical intervention:

the duration of the operation is from 10 minutes to half an hour - depends on the number of growths;
no violation occurs reproductive function– a woman after completing a recovery course can give birth;
surgery prevents development malignant neoplasms.

Removal by hysteroscopy has good feedback gynecologists and patients. The technique has disadvantages - the likelihood of infection, bleeding, but there are more advantages:

using a camera, the procedure is constantly monitored;
none painful sensations and discomfort;
removal is safe;
there is no need for stitches.

Hysteroscopy of a uterine polyp occurs according to the following plan:

general anesthesia is performed;
a gynecological dilator is inserted into the cervix;
the cavity is filled with gas to straighten the walls;
a flexible tube with a video camera is placed in it - a hysteroscope;
the position of the neoplasm, size, and quantity are determined;
removal is carried out with a special tool;
fabrics are sent to histological examination;
the wound is treated using electrocoagulation, laser, or cryogenic methods to stop bleeding and eliminate relapses.

Diagnostic curettage

The essence of this operation is the removal of the upper layer of the uterine mucosa along with growths. Diagnostic curettage is carried out according to urgent indications- Availability heavy bleeding. The procedure is characterized by:

the intervention occurs blindly;
removal of the tumor stalk becomes impossible;
The operation is scheduled three days before menstruation to prevent significant blood loss; the uterus begins to contract in a timely manner;
the appearance of complications - recurrence of growths, inflammatory processes, accumulation of blood clots in the cavity.

For achievement best results It is recommended to first remove the polyp using hysteroscopy, then diagnostic curettage to examine all endometrial tissue. Operation performed qualified specialists, eliminates the re-occurrence of growths. Indications for curettage are:

multiple endometrial polyps;
recurrent formations;
threat of developing into a malignant tumor.

Surgical intervention is performed when general anesthesia with this sequence:

produce intravenous administration anesthesia;
after anesthesia, dilatation is performed uterine walls special probe;
they scrape the surface layer of the uterus with a curette;
tissues are sent for histology;
the internal cavity is treated with iodine solution;
To contract a woman's uterus, a heating pad with ice is placed on her stomach.

Postoperative period

In order for the recovery stage after removal of growths in the uterus to go faster, it is necessary to follow the recommendations of specialists. Postoperative activities begin in the hospital. During this period the patient:

antibiotics are prescribed wide range actions to prevent inflammation and infection;
prescribe a diet to normalize intestinal motility;
Temperature monitoring is carried out in the morning and evening during the first week.

During postoperative recovery in inpatient conditions medications prescribed:

in the presence of pain - non-steroidal anti-inflammatory drugs - Loxidol, Indomethacin;
to activate intestinal function - injections of Proserpine;
in order to normalize blood circulation - Phlebodia 600;
to prevent the formation of blood clots, use anticoagulants under the supervision of a physician.

When discharged from the clinic after surgery, you must adhere to the following rules:

constantly wash the perineum in the morning and evening with intimate hygiene products or soap;
organize balanced diet to avoid constipation;
empty bladder without delay, immediately after the urge appears;
observe the work and rest schedule;
monitor the nature of postoperative discharge;
take place regularly gynecological examinations;
take medications to restore the menstrual cycle.

For quick rehabilitation after surgical intervention in the uterus to remove growths, women are contraindicated for a month:

use blood thinning medications – acetylsalicylic acid, venotonics, so as not to provoke bleeding;
swim in open water;
visit the swimming pool;
perform douching;
use tampons.

What a woman should not do after surgery

In the first days after removal of endometrial growths, minor bleeding is possible. In order to recover faster and avoid blood loss, it is necessary to take into account the recommendations of gynecologists. IN postoperative period forbidden:

visiting a sauna, bathhouse;
prolonged exposure to the sun;
lying in hot bath– you can only take a shower;
use of a solarium.

To avoid complications after uterine surgery, women need to pay close attention to their health. In the first month of rehabilitation it is unacceptable:

actively engage in sports - walking is allowed;
lift things weighing more than three kilograms;
lead sex life;
drink alcohol;
consume foods that contribute to the development of constipation;
strain during the act of defecation.

Consequences

Failure to comply with the rules of conduct and regimen during the postoperative period can provoke serious complications. After removal of the endometrial growth, the occurrence of:

recurrence of polyposis;
malignant neoplasms – if not complete removal tissues with atypical cells;
discomfort and pain during sexual intercourse;
significant bloody discharge;
long delay of the menstrual cycle.

Among unpleasant consequences surgical removal neoplasms in the uterus:

development of endometrial infection due to untreated genitourinary diseases;
infertility;
pain in the lower abdomen, perineum;
inflammation as a consequence of violation of antiseptics and lack of therapeutic measures after operation;
hematometer - accumulation of blood in the uterine cavity.

It is possible that complications may occur after diagnostic curettage:

uterine perforation - puncture of the wall in case of poor-quality expansion, loose tissue;
temperature increase;
appearance dark discharge with an unpleasant odor;
heavy uterine bleeding;
the occurrence of severe, acute pain;
cervical spasms;
the appearance of scarring;
development of the adhesive process.

Treatment after removal of a polyp in the uterus

After surgical intervention To eliminate complications, correct hormonal levels, and restore the menstrual cycle, it is necessary to undergo a course of treatment under the supervision of a doctor. Drug therapy begins in a clinic setting and continues at home. Gynecologists prescribe medications:

No-shpa - in the first days after removal to exclude hematometra;
Nokrolut, Duphaston - when identifying growths of a glandular or glandular-fibrous type, if the occurrence of polyps in the uterus is provoked hormonal imbalance;
painkillers - Dexalgin, Paracetamol.

Depending on the postoperative symptoms and with for preventive purposes recommended use:

antibacterial agents– Diclofenac, Piroxicam;
physiotherapy – magnetic therapy, UHF, electrophoresis;
douching with antiseptics - Miramistin, Chlorhexidine;
hormonal drugs to restore the menstrual cycle - Regulon, Janine;
homeopathic remedies as prescribed by a doctor;
medicinal plants– upland uterus, celandine;
dietary nutrition;
vitamin complexes For general tone body.

Hormonal correction

Gynecologists emphasize the importance of restoring hormone balance after surgery. This is of particular importance when the cause of the growths is excess estrogen and deficiency of progesterone. Lack of hormonal correction can negate the results of the operation and cause relapses. Indications for treatment are:

menstrual irregularities;
growths of glandular or glandular-fibrous nature;
hormonal disbalance.

Medications are used taking into account the woman’s age and the type of growths. Recommended hormone therapy:

for patients under 35 years of age, estrogen-gestational contraceptives are prescribed - Yarina, Regulon, Zhanine, which restore the balance of hormones and the menstrual cycle;
in the presence of formations of glandular-fibrous, glandular nature, for women over 40 years old, during menopause, use Norkolut, Duphaston, Utrozhestan;
Mirena spiral - ensures local supply of hormones to the uterus, has a minimum side effects, is set for 5 years.

After removal of the growth in the endometrium, a course of therapy using antibiotics is provided. This will help avoid dangerous consequences. Treatment antibacterial drugs prescribe:

in case of chronic genitourinary infections as a provoking factor of neoplasms;
in order to exclude relapse;
when removing polyposis using traumatic methods – diagnostic cleaning, unscrewing the leg;
to prevent the occurrence of postoperative infection;
in the presence of inflammatory processes in the reproductive organs.

In order for the doctor to correctly prescribe medications, the patient undergoes tests to identify the causative agent of the infection and its sensitivity to antibiotics. The drugs are used in the form of tablets, capsules for oral administration, solution for injection. Taking into account the severity of the condition, the complexity of the operation, and the presence of consequences, the doctor prescribes:

course of treatment – from two to ten days;
broad-spectrum antibiotics for prophylactic purposes in the absence of infection;
drugs directed against a specific pathogen.

Price

Surgery after diagnosing polyps in the uterus is carried out free of charge in public medical institutions. Unfortunately, not all of them are equipped with modern equipment. On a paid basis, removal of endometrial growths is performed under the following conditions:

commercial clinics;
specialized medical centers;
medical and rehabilitation institutions.

When planning the operation, it is necessary to take into account that diagnostic procedures and analyzes are carried out for additional fee. The cost of removing tumors in the uterus depends on the level of the clinic, the qualifications of its employees, the availability of modern equipment, and the number of polyps removed. For Moscow residents, the price of surgical intervention is:

Video

Polyps arise in the uterine cavity and affect its inner layer - the endometrium. They are a consequence of excessive growth of the mucous membrane. Neoplasms respond well to therapy, but they must be disposed of due to the risk of developing a malignant tumor.

Uterine polyps can develop into cancer, so they need to be removed

What are the causes of the formation of uterine polyps

Uterine neoplasms appear in girls and women of various age groups. The doctor diagnoses the disease if the patient has complaints. Sometimes polyps are discovered during a routine examination due to asymptomatic diseases.

Gynecologists name the following main causes of uterine polyps:

Disturbances in the production of hormones (lack of progesterone and excessive production of estrogen).
Acute or chronic inflammation female reproductive system.
Intensive growth of blood vessels or their clogging.
Damage to the lining of the uterus, which may be associated with frequent curettages, difficult childbirth, or as complications of abortion.
Complications after suffering inflammation of the uterine mucosa and others.

When diagnosing a uterine polyp, the gynecologist advises the patient to get rid of the formation and do additional tests to eliminate the causes of its occurrence. If this is not done, the disease will return after a while.

Blockage of blood vessels in the uterus leads to the formation of polyps

Treatment methods for polyps

Modern medicine has gained extensive experience in the treatment of uterine polyps in a conservative and surgical manner. The gynecologist chooses a treatment method that suits each patient individually.

Drug treatment of uterine polyps is often prescribed to girls or nulliparous women, if the formation is single and small. This treatment method prevents complications. After the course, the patient is observed by a doctor to prevent relapse.

Removing a polyp through surgery is a common and reliable way to get rid of the formation. Modern medicine carries out this procedure with the least risk to a woman’s health.

Doctors call indications for surgical intervention:

Ineffectiveness of conservative treatment.
Age (women over 40 years old).
The size of the formation is over 1 cm.
A malignant tumor forms from a polyp.

Removal of a polyp in the uterine cavity is often performed using curettage, hysteroscopy or laparoscopy. These procedures allow you to gently get rid of the problem and prevent its recurrence.

Medicines are only effective in cases with small polyps

Consequences of removal of a uterine polyp

Removing these formations surgically can cause complications. The sick person monitors her condition at home and should definitely contact her doctor if the temperature rises after the intervention and is bothering her. profuse bleeding with an unpleasant odor and severe pain in the lower abdomen.

Doctors consider bloody discharge to be normal, which decreases in intensity until the 10th day after removal of polyps. Continued bleeding is a reason to visit a doctor. If vaginal discharge have an uncharacteristic odor or an admixture of pus, the patient should also seek help.

Scraping can have the following consequences:

Inflammation of the uterus (rarely occurs when sanitary and hygienic standards are violated during the procedure or in the presence of infection).
Perforation (rupture) of the uterus (large ruptures need to be sutured, but small ones heal on their own).
Hematometer (blood collects in the lumen of the uterus and there is no outflow). Availability severe pain and a sudden cessation of discharge are the main symptoms of complications after polyp removal. A woman is at risk of infection if appropriate therapy is not started.

The main consequences of removing a tumor using hysteroscopy are bleeding for several hours after the intervention. Then the patient should observe only spotting. If the bleeding continues, the woman may develop anemia and general malaise. Such conditions require additional treatment.

After surgical removal of polyps, the patient’s menstrual cycle changes. The reason to contact a specialist is menstruation, during which the release of blood lasts more than a week.

Polyps in the uterus very rarely degenerate into malignant tumors. But they require removal using a conservative or surgical method. Any operation can negatively affect a woman's health. This depends on the state of her health and the characteristics of the body’s reaction to the intervention.

An endometrial polyp is one of the types of endometrial hyperplasia, that is, the growth of its inner layer. The formation cells can gradually accumulate changes that are regarded as precancer, and then transform into endometrial cancer. So the uterine polyp itself is not a precancerous disease, but it is a precancer.

Most precise method Diagnosis of the disease is during which a biopsy of the polyp is performed, and subsequently its histological examination, that is, it is determined what cells and tissues it consists of. Any that was detected during hysteroscopy must be removed.

How to remove a uterine polyp

Many studies have proven that diagnostic curettage does not allow getting rid of these formations in all cases. Polyps consisting of dense tissues - muscle, fibrous (you can learn more about glandular-fibrous polyps from ours) are especially poorly removed in this way - the frequency of their disappearance after curettage is only 12%. Even simultaneous endoscopic control does not avoid relapses of the disease.

Effective removal of pathological tissue should affect the entire endometrium located under the formation, down to its deep basal layer. This can only be achieved by performing hysteroscopic intervention.

Methods for removing endometrial polyps involve the use of conventional hysteroscopic equipment, as well as the use of electrosurgical equipment or a laser guide. Removal of endometrial polyp with laser – modern technology, allowing you to completely get rid of unnecessary tissue, reduce the likelihood of bleeding from the removal point, and reduce the frequency of relapses. However, conventional hysteroresectoscopy with proper preparation and implementation has very good results.

How to prepare for surgery

Before removing uterine polyps, the following diagnostic measures are carried out:

examination of the cervix in mirrors, which helps to assess its condition, the shape of the cervical canal, the presence of an inflammatory process or damage to the organ; this is important because it is through cervical canal instruments will be introduced to manipulate the uterus;
bacteriological examination of smears from the surface of the cervix and vaginal walls to prove that the woman does not have bacterial inflammation genital organs, because otherwise there is a risk of infection in the uterus, which will cause endometritis;
cytology smear;
transvaginal ultrasound, in which a transducer is placed in the vagina and the uterus is examined without interference from the abdominal wall;
general clinical examination - blood tests (general and biochemical) and urine, blood tests for HIV, markers viral hepatitis, electrocardiogram, fluorography of the lungs, examination by a therapist.

Contraindications for polyp removal:

inflammatory diseases of the vagina, cervix, uterus or appendages, caused by both common flora and sexually transmitted infections (for example) - surgery is performed after getting rid of these diseases;
exacerbation of genital (thrush) or (vaginal dysbiosis);
intense bleeding from the genital tract caused by endometrial hyperplasia or other causes until it stops;
pregnancy;
cervical pathology that prevents the passage of hysteroscopic instruments into the uterine cavity (cancer, stenosis, gross cicatricial deformation after ruptures during childbirth, and so on);
severe concomitant diseases in the stage of decompensation (for example, diabetes mellitus with high levels of blood glucose and glycated hemoglobin, arterial hypertension with high numbers blood pressure) or exacerbation (for example, peptic ulcer stomach, bronchial asthma and others);
acute respiratory infection.

No special preparation is required for endometrial polyp removal. During the week before the procedure, sexual rest or the use of a condom is desirable. It is better not to use douches, vaginal tablets, suppositories and creams for any purpose.

On the day before the operation, you can take easily digestible food for lunch, excluding brown bread, cabbage, legumes, and it is better to refuse dinner or drink a glass of kefir. Liquid is not limited. On the morning of the operation, you should not eat breakfast or drink. In the evening and in the morning, a cleansing enema is performed as prescribed by the doctor.

The appropriate time for the operation is determined by the doctor, usually 2-3 days after the end of menstruation, that is, days 6-9 of the cycle, since at this time the endometrium has not yet recovered, but its menstrual rejection has already been completed. These days, polyps are better visible, they are easier to remove, and the operation is less likely to be accompanied by complications, such as bleeding.

Surgery

Surgery to remove an endometrial polyp is usually performed in a hospital. Hospitalization periods are short, do not exceed several days.

The patient is placed on a gynecological chair, and painkillers are administered intravenously. At the same time, the woman falls asleep and does not feel anything. General intravenous anesthesia can be replaced by spinal anesthesia or even endotracheal anesthesia. The decision on the type of anesthesia is made by the anesthesiologist depending on many factors, including:

the likely duration of the manipulation and its volume;
accompanying illnesses;
intolerance medicines, cases of allergies to the administration of painkillers;
the possibility of complications during the operation.

In any case, adequate pain relief is necessary, since when the cervical canal is expanded for the introduction of a hysteroscope, pain and other negative reactions may occur.

How is the operation performed?

After putting the patient under anesthesia, the gynecologist treats the external genitalia with an antiseptic solution and inserts cervical canal dilators - special instruments that “stretch” the canal to the required size for free insertion of the hysteroscope. The uterine cavity is filled with liquid or gas to straighten its walls.

An effective method for removing endometrial polyps is hysteroresectoscopy.

Single polyps with a clearly visible stalk are removed using scissors or forceps inserted through the hysteroscope channel. These instruments, under visual control (the hysteroscope is equipped with a miniature video camera that allows you to see the operation area), are passed to the stalk of the polyp and cut through it. This procedure can be performed using a resectoscope loop. In the same way they carry out laser removal polyp. After removal, the intervention site is carefully examined again to ensure that there is no formation.

If the polyp is located near the mouth of the fallopian tubes, technical difficulties of the operation arise, because in this place the uterine wall is very thin, only 3-4 mm, and the risk of damage increases. Therefore, mechanical separation of the polyp is used, and electrical resection is most often abandoned.

Resectoscopy using a loop electrode (electrosurgical polypectomy) is more often used to remove large formations located near the uterine wall (parietal) that have a dense fibrous structure. The loop is brought to the polyp and cut off to the base. If the removal is carried out mechanically, then it is first unscrewed, and then the polyp stalk is additionally removed with scissors or forceps inserted through the hysteroscope. In this case, the cervical canal is dilated with Hegar dilators.

How long does the removal take? The time of intervention depends on the complexity of the operation, the size of the polyp, its location, the experience of the gynecologist and many other factors. On average, the manipulation takes about 30 minutes. In case of multiple formations, technical difficulties when inserting a hysteroscope or removing the formation itself, the intervention takes longer. The duration of anesthesia is also increased if necessary.

Period after surgery

Normally, within 2-3 days after removal of the endometrial polyp, the patient experiences discharge . They are scanty, “smearing” and go away on their own as soon as the removal site “heals”. The patient may experience minor discomfort in the lower abdomen and in the area of the external genitalia; this is not dangerous and is associated with restoration of the cervix.

If your stomach hurts after the intervention, the doctor will prescribe painkillers. You can use funds in the form rectal suppositories, they are safer and no less effective than regular pain pills.

If pain intensifies and bleeding increases, as well as if it lasts more than 5-6 days, you should immediately consult a doctor. Such signs indicate complications of the procedure.

Negative consequences of hysteroscopy and polyp removal:

perforation (perforation) of the uterine wall;
bleeding from the site of removal of the formation.

During the first 2-3 days, a woman's temperature may rise. Most often this is a consequence of exacerbation of a chronic inflammatory process in fallopian tubes. In addition, after the removal of multiple polyps in the uterine wall, aseptic (microbial-free) inflammation occurs - natural reaction body, aimed at restoring the integrity of the mucous membrane.

When complications occur, repeated hysteroscopy is often performed, as well as curettage of the uterine cavity, antibiotics, detoxification agents, and hormones are prescribed.

sexual rest for a week while the cervix continues to recover;
refusal to use vaginal tampons;
You should not douche or use vaginal dosage forms without a doctor’s prescription.

What not to do during the first week after surgery:

visit a sauna, bathhouse;
take a hot bath;
go to the pool or solarium;
play sports, do hard physical work.

The main questions that arise in the long-term period after polyp removal

When will your period start?

Despite the removal of the formation, the woman’s hormonal levels are not disturbed, therefore, menstruation after removal of the endometrial polyp occurs on time, only a slight deviation in the timing of the onset of menstruation is possible . Heavy periods are a variant of the normal course of the recovery period. However, if they develop into uterine bleeding, you should urgently consult a doctor.

When can you get pregnant?

Pregnancy after removal of an endometrial polyp can occur already in the current cycle if hormonal therapy is not started. However, this is not a completely favorable development of events, because the woman needs rehabilitation for a full recovery.

The optimal period for the inner layer of the uterus to completely recover is 3 months. It is for this period that combined oral contraceptives are prescribed. Their cancellation causes the so-called rebound effect, as a result of which the likelihood of pregnancy increases. If endometrial polyps were the cause, it is at this time that the most favorable moment for conception.

What treatment is prescribed after removal of an endometrial polyp?

The question of the appropriateness of the appointment hormonal drugs remains controversial. Some doctors believe that when removing a small polyp drug therapy may not be carried out. Others argue that hormonal therapy is useful because it improves recovery normal function endometrium. Hormones are prescribed for functional glandular polyps, adenomatous formations, as well as for the combination of polyps with endometrial hyperplasia.

Usually combined or progestogens (Duphaston) are prescribed. The choice of drug, its dosage and duration of administration is determined by the doctor. Usually it is 3 months. Often, a woman is offered to install it with the content of levonorgestrel - “”. These measures, in addition to restoring endometrial function, are also aimed at planning pregnancy.

Clinical observation of a patient who has undergone polyp removal is carried out for a year.

The reason for the appearance of a uterine polyp is hyperplasia, that is, the growth of the endometrium. This layer lines the organ from the inside. When hormonal imbalances occur, the endometrium thickens, sometimes forming mushroom-shaped or papillary formations. Some polyps (adenomatous) are precancer.

Any hyperplastic processes cause uterine bleeding. Therefore, surgery to remove a polyp in the uterus should be performed on any woman with this diagnosis. According to different authors, this pathology is observed in 5–25% of all gynecological patients, mainly in the group over 45 years of age.

Treatment tactics

Drug treatment can slow the growth of polyps or prevent their recurrence. But immediately after stopping taking hormones, these formations begin to grow again. For conservative therapy, it is proposed that it contains gestagens that have therapeutic, preventive and contraceptive effects.

Almost any should be removed. This is necessary to prevent uterine bleeding and degeneration into a malignant tumor. Methods for removing a polyp may be different, but all of them are performed only using hysteroscopy.

Numerous medical research have proven that removing a polyp by curettage does not always allow for complete excision of this formation. This is especially true for fibrous polyps, which disappear in only 12% of women when using this method. Even with the use of hysteroscopy, the disease recurs in 26-78% of patients.

The procedure for removing a polyp in the uterus should include excision of the underlying (basal) layer of the endometrium, then its effectiveness increases. Such an operation can be performed using mechanical instruments, electrosurgery, laser or other modern equipment.

Treatment after polyp removal depends on the type of formation. This issue is still actively discussed by doctors, and they do not have a consensus. It is believed that hormonal therapy is necessary after removal of glandular functional and adenomatous polyps, as well as when such formations are combined with diffuse ones. The treatment regimen is selected individually depending on age and other factors.

Indications and contraindications for surgery

The final decision on whether to remove the endometrial polyp rests with the patient. The doctor should explain to her whether there is a high probability of malignant degeneration of the formation and other complications.

Degeneration into cancer is observed in 1% of all cases. The incidence of malignancy is not related to the size of the formation, that is, both large and small nodules can become malignant with equal probability. The risk of this outcome increases in older women with uterine bleeding.

If the polyp does not cause any symptoms, then in 25% of cases it disappears on its own within a year, especially if its diameter is less than 1 cm. If an asymptomatic formation is found in a postmenopausal woman, observation only may be recommended at first. Immediate surgery is only required if there is a family history of uterine cancer.

large formations with a diameter of more than 1 cm, often causing uterine bleeding or leading to infertility;
the patient's age is over 40 years, when hormonal changes can transform endometrial hyperplasia into precancer and;
ineffectiveness of medications used for dysfunctional bleeding;
infertility and spontaneous abortion caused by formations in the uterine cavity;
, which is always a precancerous process.

Removal of endometrial polyps is contraindicated in grades II-IV, as well as in severe general condition patients associated with other diseases (diabetes decompensation, cerebrovascular accident, severe hypertension, heart failure III-IV functional class and etc.). In case of profuse uterine bleeding, curettage or removal of the uterus.

The operation is carried out in the following cases:

acute infections (angina, ARVI, exacerbation of pyelonephritis or cystitis, thrombophlebitis, etc.);
inflammatory diseases of the genital organs in the acute stage (vaginitis, colpitis, cervicitis, endometritis, adnexitis);
vaginal smears of III-IV degree of purity;
pregnancy.

Preparation

Excision of endometrial formation occurs most often during planned procedures. Preparation for surgery to remove a uterine polyp includes:

blood and urine tests;
vaginal smear to determine the degree of purity;
at concomitant diseases(diabetes, hypertension), consultation with a specialized specialist (endocrinologist, cardiologist) is indicated.

In the evening before the study, it is advisable to do a cleansing enema. You can have a light dinner; you should not drink or eat anything in the morning before surgery. Immediately before hysteroscopy, the bladder should be emptied.

The operation can be performed in a one-day hospital, but only if, if necessary, the patient can be quickly transferred to a hospital department. For elderly women, nulliparous and overly emotional patients, it is recommended to remove the endometrial polyp only in a hospital.

On what day of the cycle is a uterine polyp removed?

It is best to do this 5-7 days after the start of menstruation. At this time, the endometrium is thin, the formation is clearly visible, and the risk of postoperative bleeding is much lower.

If a woman has entered perimenopause, that is, monthly cycle her bleeding has become irregular, bleeding is rare and scanty, and in elderly patients the day of surgery does not matter.

Stages of implementation

The operation in 95% of cases is performed under general intravenous anesthesia; in the remaining 5% of patients, epidural anesthesia is used (usually in cases of intolerance to certain pain medications or severe concomitant diseases).

Various methods are used to remove an endometrial polyp:

scraping;
hysteroresectoscopy;

During curettage and hysteroresectoscopy, the woman lies down on a gynecological chair, after which she is given anesthesia.

For (curettage), the doctor uses a long, thin metal instrument with a loop at the end or special forceps. After cleansing the walls of the uterus, it is necessary to do a hysteroscopy to ensure complete removal of the endometrium. This procedure is indicated for suspected uterine cancer, since during it a large number of tissue for microscopic examination.

In case of multiple formations, vacuum removal of the polyp can be performed. This intervention is less traumatic than curettage, but its effectiveness is lower. The endometrial tissue is sucked out using a special device.

The best treatment method is hysteroresectoscopy, or polypectomy. It is used if the patient has uterine bleeding but there is no suspicion of cancer.

How is a polyp removed during hysteroscopy?

The external genitalia are treated with an antiseptic solution and a bimanual examination is performed.
The cervix is fixed with bullet forceps, the cervical canal is expanded using metal rods of successively increasing diameter.
A hysteroscope with a miniature light guide, a video camera and instruments is inserted into the uterine cavity.
There are mini-hysteroscopes that allow you to remove small growths without expanding the cervical canal.
Examined using a hysteroscope inner surface uterus, find the polyp and remove it using a loop heated with electric current, or remove a polyp in the uterus with a laser.

The operation lasts about 45 minutes. It is accompanied by removal of the base of the polyp, which reduces the likelihood of relapse. Reappearance such formation is observed in 2-5% of cases and is usually observed during the first year after the intervention. Resection is very effective for the prevention and treatment of uterine bleeding, including postmenopausal bleeding. It increases the chances of success and the likelihood of spontaneous pregnancy.

The postoperative period is short. The patient is under the supervision of doctors for several hours, a maximum of a day, until she recovers from anesthesia. If there are no complications, she is discharged home. It is advisable that the woman be accompanied by one of her relatives. Due to epidural or general anesthesia, her attention may be impaired, so driving in the first 1-2 days after the intervention is not recommended.

If, despite all efforts, the polyps recur and are accompanied by bleeding, the uterus is removed - a hysterectomy.

Modern methods of treatment

When removing a polyp using mechanical instruments (forceps, scissors), bleeding from its base is possible. Therefore, most often, an electric loop is used, which cauterizes the remaining tissue. However, as a result of such exposure, a small scar may appear on the uterine mucosa.

Laser removal of polyps in the uterus does not have this drawback. It is performed during hysteroscopy using a light beam that gradually “evaporates” tissue pathological formation. This is a non-contact method, it is not accompanied by damage to the surrounding mucous membrane, and does not cause tissue burns. When using a laser, there is no risk of postoperative bleeding. The scar on the mucous membrane either does not remain, or it is very small, which does not prevent subsequent pregnancy.

In modern clinics it is used radio wave removal uterine polyp. This is a safe and effective method of removing pathological formations, based on the “evaporation” of altered cells under the influence of radio waves. There is no contact with blood, there is no risk of burns, and postoperative bleeding does not develop. To remove polyps, you can choose either laser technique, and radio waves, they have the same efficiency.

Possible complications

Depending on the type of intervention, the adverse consequences of the operation may vary. The safest are laser and radio wave removal.

One of the most serious complications– perforation of the uterus, that is, the formation of a through hole in its wall. It can occur both during curettage and during hysteroscopy, usually at the stage of expansion of the cervical canal.

This complication appears soon after the intervention. Its main features:

bleeding;
severe pain in the lower abdomen;
weakness, decreased blood pressure, dizziness and shortness of breath (symptoms of blood loss);
V severe cases When inflammation of the peritoneum develops, stool retention and bloating occur.

If the uterus is perforated, surgery is necessary to close the defect.

If an infection enters the uterine cavity, for example, with concomitant inflammation in the genital tract, it may develop. In this condition, the temperature rises, nagging pain in the abdomen, bloody, and then purulent discharge from the vagina. The development of endometritis often requires curettage. Antibiotics are required. To prevent such a complication, it is necessary to remove the polyp only in the absence of acute inflammatory processes, and after the intervention, follow all the doctor’s recommendations.

Due to repeated curettage, adhesions - synechiae, as well as replacement, can form in the uterine cavity. normal endometrium connective tissue. This leads to infertility or. Therefore, women planning to have children are recommended low-traumatic treatment methods - laser or radio wave removal.

In some patients, after hysteroscopy, cervical spasm occurs with blood retention in the organ cavity. This is how a hematometra appears. Are created in the uterus favorable conditions for the development of infection and suppuration. A woman complains that her lower back and lower abdomen hurt, and there is no discharge from the genital tract. The temperature is moderately elevated. The skin is pale and dry. With a hematometer, it is necessary to evacuate blood from the uterine cavity and prescribe antibiotics.

Recovery after polyp removal

The doctor who performed the operation should tell you about the features of the recovery period, including what kind of discharge after removal of a uterine polyp. Usually within 3-5 days a small amount of brown contents is released from the vagina. If red blood appears, you should consult a gynecologist.

Many women experience pain after the procedure. They are weak and aching. To get rid of painful sensations can be accepted antispasmodic(No-shpa, Bral). If you experience severe cramping pain, you should visit a doctor.

Complete restoration of the uterus after removal of the polyp using hysteroscopy occurs within a month. At this time it is usually prescribed hormonal drugs, restoring the inner surface of the uterus and promoting endometrial regeneration. If one small polyp was removed, additional medications usually not prescribed. All questions regarding the use of hormones are resolved individually together with the doctor.

do not lift objects weighing more than 3 kg, limit sports activities;
do not visit the swimming pool, bathhouse, sauna;
refuse physical procedures;
do not take a hot bath;
limit the use of medications that can cause bleeding (Aspirin, Diclofenac);
use condoms during sexual intercourse;
do not douche or use vaginal tampons.

All these tips should be followed for a month after the intervention. But after scraping recovery period extends to 3-6 months.

Since removal of the polyp does not affect hormonal background patients whose periods come on time after surgery. Sometimes they can shift a few days earlier or later; this is a normal reaction of the body. For some women, the first periods after the intervention are heavier than usual, but then the cycle returns to normal.

Pregnancy after removal of a polyp in the uterus is possible even before the onset of the first menstruation. However, this must be avoided so that the mucous membrane recovers well. In addition, sexual intercourse without a condom in the first month is dangerous due to the development of infection in the uterus.

Often, rehabilitation of patients includes an appointment for a period of 3 months. Are used combination drugs containing gestagens and estrogens, for example, Yarina. Under their influence, the cycle is normalized, the functioning of the ovaries is restored, and the condition of the endometrium improves.

After discontinuation of such drugs, a “withdrawal effect” occurs - at this time the likelihood of pregnancy increases. If the polyp was the cause of infertility in the patient, this can be used to conceive a child.

For women over 35 years of age, it is preferable to prescribe gestagens, for example, Duphaston. Excessive estrogen stimulation at this age can lead to malignant degeneration endometrium.

If a woman does not plan to become pregnant, she is offered to install intrauterine device"Mirena". It contains a gestagenic substance that restores the endometrium and protects against pregnancy.

After surgery, you must regularly visit your gynecologist. Typically, an examination is scheduled 2 weeks after the intervention, when the results of a biopsy of the removed lesion are ready. Depending on the type of polyp (fibrous, adenomatous, etc.) tactics further treatment may change.

At your appointment, you should ask your doctor whether you should take hormonal medications and when to have an ultrasound. Usually the course oral contraceptives lasts 3 months, and then a control ultrasound is done. In the future, it is recommended to repeat this study annually.

Polypous formations of the endometrium often recur. Prevention of uterine polyps after removal includes:

Treatment by an experienced doctor who will carefully remove the formation.
Taking recommended hormonal medications.
Contact a gynecologist for any unfavorable symptoms.
Pregnancy planning.

Removal of the uterine mass using hysteroscopy followed by hormonal treatment often allows you to get rid of the disease, and, if desired, get pregnant.