Uterine Polyps for NP
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Uterine Polyps for the Nurse Practitioner Licensing Exam
Definition and Pathophysiology
- Definition
- Uterine polyps are benign growths of the endometrial lining that extend into the uterine cavity, typically composed of endometrial glands, stroma, and blood vessels.
- Polyps can be small or large, sessile (flat-based) or pedunculated (stalked), and are usually found in
- Pathophysiology
- Polyps develop from localized overgrowth of endometrial cells, with estrogen playing a key role in their formation and growth.
- Genetic mutations, including those affecting the PTEN gene, may also contribute by promoting cellular proliferation.
Risk Factors
- Hormonal Factors: Unopposed estrogen, including that associated with tamoxifen therapy, increases polyp formation.
- Age: Commonly found in women aged 40-50 and postmenopausal patients.
- Obesity: Elevated body fat raises estrogen levels through peripheral conversion, increasing risk.
Clinical Manifestations
- Abnormal Uterine Bleeding (AUB):
- The most common symptom, presenting as irregular bleeding, heavy menstrual periods, or postmenopausal bleeding.
- Infertility:
- Polyps can interfere with embryo implantation and are associated with infertility; polypectomy may improve fertility in affected women.
- Asymptomatic: Polyps may be incidentally discovered on imaging in asymptomatic patients.
Diagnosis
- Transvaginal Ultrasound (TVUS): The first-line imaging tool for detecting polyps, often revealing focal endometrial thickenings.
- Saline Infusion Sonohysterography (SIS): Enhances ultrasound visualization, particularly helpful for smaller polyps.
- Hysteroscopy: Gold standard for diagnosis, allowing direct visualization, biopsy, and removal if needed.
Management
- Observation: Asymptomatic, small polyps may be monitored, especially in premenopausal women.
- Hysteroscopic Polypectomy: Indicated for symptomatic polyps, infertility, or postmenopausal bleeding due to potential malignancy risk.
Key Points
- Uterine Polyps are benign endometrial overgrowths causing abnormal uterine bleeding, commonly seen in perimenopausal and postmenopausal women.
- Risk Factors: High estrogen levels, tamoxifen use, age, and obesity.
- Symptoms: Abnormal uterine bleeding, including spotting, heavy periods, or postmenopausal bleeding; polyps may also contribute to infertility.
- Diagnosis: Relies on transvaginal ultrasound, saline infusion sonohysterography, and hysteroscopy for definitive assessment and removal.
- Management: Observation for asymptomatic cases, with hysteroscopic removal indicated for symptomatic or suspicious polyps, particularly in postmenopausal women.