انا حالياً منفصل من اربع اسنين وكل ماتقدملي احد اخاف وسبب المشكلة اني لما تزوج اصابني نزيف من اول يوم ودخلت في متهات امراض النساء ونتيجة الفحوصات اني كان عندي اورام حميد (يسمونها بولب أو لحميات على عنق الرحم وداخلة ) وبطانة الرحم نشطة شلت الورام وسولي تنضيفات اكثر من مرة الا اني رجعت انزف ووقت الجماع ماكنت اقدر اكمل من العوار واستمريت على هالموال حولى سنة بين نزيف وعوار ليمن تطلقت وبعد الطلاق توقف النزيف بدون علاج كن كان النزيف معى نفسية وبعد سنتين حسيت بثقل وعوار بالرحم لما راجعت دكتوري اول ما حط لى الفحص المهبلي نزل من دم موطبيعي الي وسخ السريروصار بقعة كبيرة وقالي الدكتور ان عندىلخبطة في الهرمونات و لحمية داخل الرحم وشلتها و عملت تنظيفات وصارلي مدة اخذ حبوب منع الحمل وبعدين ابر توقف التبويض لإن عندي سكيس في المبيضين وحلياً انا موقاعدة انزف والحمد لله بس عندي عوار اسفل البطن والمشكلة ان كل ماتقدملى واحد ارفض اخاف يصيبني نفس النزيف والعوار وصار عندي رهبه من الجماع لدرجة ما تتصورها سأأأأأأأأأأأأأأأأأأأعدني ارجوووووووك

اختي الكريمة
ما تم عمله لكي هو المكتوب في الكتب و لكن هل تم تحليل الزوائد و عينه من جدار الرحم ? و كذلك هل تعاني من مشاكل في تجلط الدم بمعني و ظائف الصفائح الدموية عددا او وظيفة? و كذلك هل تعاني من التهابات متكرره في المهبل?
سوف اضع لكي هنا ما هو مكتوب بهذا الخصوص , و لكني اجد ان النزيف كان زائد عندك و معه الم و لابد من فحوصات للوصول الي نتيجه و ممكن تزوري اولا استشاري امراض دم لفحص اي سبب للنزيف.
اكيد لابد من الانتظار علي الزواج حتي معرفة تشخيصك اولا




Endometrial polyps

Elizabeth A Stewart, MD


UpToDate performs a continuous review of over 350 journals and other resources. Updates are added as important new information is published. The literature review for version 14.2 is current through April 2006; this topic was last changed on April 11, 2006. The next version of UpToDate (14.3) will be released in October 2006.

INTRODUCTION — Endometrial polyps are localized hyperplastic overgrowths of endometrial glands and stroma around a vascular core that form a sessile or pedunculated projection from the surface of the endometrium. Single or multiple polyps can occur that range from a few millimeters to several centimeters in size. They rarely contain foci of neoplastic growth. In one large series of 509 consecutive women with endometrial polyps removed by operative hysteroscopy, histology was benign in 70 percent, and showed hyperplasia without atypia in 26 percent, hyperplasia with atypia in 3 percent, and cancer in 0.8 percent [1]. The mean age of the women was 56 years and just over one-half had abnormal uterine bleeding.

EPIDEMIOLOGY — Endometrial polyps are rare among women younger than 20 years of age. The incidence rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause. Among women undergoing endometrial biopsy or hysterectomy, the prevalence of endometrial polyps is 10 to 24 percent [2]. Large endometrial polyps can also be associated with tamoxifen use; these polyps may be associated with a higher risk of neoplasia [3,4].

CLINICAL FEATURES — Endometrial polyps are responsible for approximately one-fourth of cases of abnormal genital bleeding in both premenopausal and postmenopausal women [2]. (See "Terminology and evaluation of abnormal uterine bleeding in premenopausal women" and see "Evaluation and management of uterine bleeding in postmenopausal women").

Metrorrhagia (ie, irregular bleeding) is the most frequent symptom in women with endometrial polyps, occurring in about one-half of symptomatic cases. Less frequent symptoms include menorrhagia, postmenopausal bleeding, prolapse through the cervical os, and breakthrough bleeding during hormonal therapy. Many polyps are asymptomatic [5].

It is controversial whether endometrial polyps contribute to infertility or poor pregnancy outcomes such as miscarriage [6]. However, since it can be difficult to differentiate polyps from submucous leiomyomas on diagnositic testing, and cavitary distortion with fibroids appears to decrease successful pregnancies, most practitioners routinely remove polyps prior to an IVF cycle. (See "Treatment" below).

DIAGNOSIS — Endometrial polyps are diagnosed by microscopic examination of a specimen obtained after curettage, endometrial biopsy, or hysterectomy. Excision permits both diagnosis and cure of these lesions. Neither ultrasonography nor hysteroscopy can reliably distinguish between benign and malignant polyps [7,8].

Sonohysterography — Sonohysterography (saline infusion sonogram) is the most useful noninvasive modality for evaluating polyps in women with abnormal uterine bleeding (show radiograph 1 and show radiograph 2 and show radiograph 3). In one report, 106 women with menometrorrhagia underwent transvaginal ultrasonographic examination, sonohysterography, and diagnostic hysteroscopy with guided biopsy to determine if an endometrial polyp was present [9]. Sonohysterography was significantly more accurate than ultrasound alone in making a diagnosis, with a higher sensitivity (93 versus 65 percent) and specificity (94 versus 76 percent) than transvaginal ultrasonography. (See "Saline infusion sonohysterography"). Three-dimentional ultrasound may also be used in the future, either alone or with saline infusion (show radiograph 4) [10].

NATURAL HISTORY — A prospective study on the course of endometrial polyps performed two saline infusion sonograms 2.5 years apart on 64 initially asymptomatic women (mean age 44 years) [11]. Seven women had polyps on the first examination. Four of these women had spontaneous regression of their polyps at the second scan, while seven women developed new polyps over the 2.5 year interval. Polyps larger than 1 cm were least likely to regress. Hormone use did not appear to affect the natural history of the polyps, but the study sample was small.

TREATMENT — Thorough curettage cures the majority of cases of endometrial polyps, this approach can miss lesions. Curettage followed by blind extraction with Randall polyp forceps improves the detection rate over curettage alone [12]. Hysteroscopic-guided removal with forceps, suction curette, scissors, or a small electrosurgical loop is now recommended since small polyps and other structural abnormalities can be missed by blind curettage [13-15].

For women desiring pregnancy, short-term downregulation with a GnRH-agonist may be useful. However, clinical experience with this approach is restricted to a few case reports and symptoms reappear after discontinuation of agonist therapy. In a randomized trial with inclusion criteria 24 months infertility, candidate for intrauterine insemination, and histologically confirmed sonographic diagnosis of endometrial polyp, hysteroscopic polypectomy before intrauterine insemination was associated with a significantly higher pregnancy rate (63 versus 28 percent in controls) [16]. Based on this trial, and other data from observational studies, we remove endometrial polyps in infertile women, even in the absence of abnormal bleeding.

There are no data from randomized trials to guide therapy of asymptomatic polyps. We suggest removal of polyps of any size in asymptomatic women with risk factors for endometrial hyperplasia or carcinoma (eg, postmenopausal; family or personal history of ovarian, breast, colon, or endometrial cancer; tamoxifen use; chronic anovulation; obesity; estrogen therapy; prior endometrial hyperplasia). In asymptomatic women without risk factors, we perform polypectomy when there are multiple polyps or, in premenopausal women, a single polyp exceeding 2 cm or, in postmenopausal women, a single polyp exceeding 2 cm.

In the absence of risk factors for endometrial hyperplasia/cancer, asymptomatic polyps of 2 cm in premenopausal women or 1 cm in postmenopausal women are more likely to regress; therefore, we manage these cases expectantly.

SUMMARY AND RECOMMENDATIONS

Abnormal uterine bleeding, especially irregular bleeding, is the most frequent symptom associated with endometrial polyps.
Sonohysterography is the most useful noninvasive diagnostic modality.
Hysteroscopic-guided curettage is recommended to excise symptomatic polyps since small polyps and other structural abnormalities can be missed by blind curettage.
In infertile women with endometrial polyps, removal should be considered as part of the treatment of infertility.
We recommend removal of symptomatic polyps (eg, bleeding, infertility) (Grade 1C). (See "Treatment" above).
We suggest removal of asymptomatic polyps of any size in women with risk factors for endometrial hyperplasia/cancer (Grade 2C). In women without risk factors, we suggest removing asymptomatic polyps when there are multiple polyps or, in premenopausal women, a single polyp exceeding 2 centimeters or, in postmenopausal women, a polyp exceeding 1 cm (Grade 2C). (See "Treatment" above).
We suggest expectant management of asymptomatic polyps 2 cm or less in premenopausal women or 1 cm or less in postmenopausal women without risk factors for endometrial hyperplasia/cancer since these polyps are more likely to regress (Grade 2C).

د.نبيل