The six highest estrogen binding herbs are soy, licorice, red clover, thyme, turmeric hops, and Verbena [ 13 ]. Although not on exogenous drugs, the patient described by Narin et al.
The patient described by Meena et al. However, she had several risk factors including postmenopausal status, obesity, diabetes mellitus, and hypertension. Similarly, the patient in the case by Unal et al. In addition to their menopausal status, both of our patients have medical comorbidities that may be risk factors for malignant transformation of polyps including hypertension, obesity, and type 2 diabetes mellitus.
It is interesting to note that 8 of the 12 patients described were of Turkish or Mediterranean origin. It is possible that there are genetic, dietary, or ethnic factors related to the development of large polyps; however, with such a small incidence and limited reporting, no conclusions can be inferred.
The rationale for removing polyps is to exclude malignancy and to relieve symptomatic vaginal bleeding. Management of small asymptomatic polyps may be conservative with follow-up.
However, conservative management should be undertaken with caution in postmenopausal patients, patients with any risk factors, or those with polyps measuring greater than 1. Risk factors for malignancy differ among reports and populations; however, larger size, advanced age, menopausal status, obesity, diabetes, arterial hypertension, and tamoxifen use have been associated with malignancy.
Hysteroscopic polypectomy remains the mainstay of evaluation and operative management of endometrial polyps as the associated morbidity is minimal when compared to a hysterectomy. Operative hysteroscopy allows for visualization of the entire uterine cavity. There are a variety of methods practiced to remove polyps at hysteroscopy sharp scissors, electrosurgical techniques ; however, there are no comparative studies for these methods with regard to efficacy. Therefore, the method of choice should be one that is most familiar to the surgeon.
Regardless of which method is employed, removal of the entire polyp, including complete excision of the polyp stalk, should be achieved. Therefore, blind curettage should not be used as a diagnostic or therapeutic intervention [ 4 ]. If malignancy is found within the polyp, the patient should be referred to a gynecological oncology specialist for further staging and management.
It should be emphasized that the clinical implications and oncogenic potential of large and giant endometrial polyps are still unclear in the literature. Information is currently derived from small studies, case series, and case reports. The pathogenesis of endometrial polyps as well as factors leading to oncogenesis is still being elucidated.
Therefore, with these limitations in knowledge, caution should be taken when counseling patients that present with large or giant endometrial polyps. Consent was obtained for publication of case and images from both patients and can be provided on request. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Academic Editor: Julio Rosa-e-Silva. Received 10 Mar Accepted 07 May Published 07 Jun Introduction Endometrial polyps are localized overgrowths of the endometrial lining of the uterus. Case Series 2. Case 1 FM is a year-old postmenopausal black female who presented with a chief complaint of intermittent vaginal spotting since the age of Figure 1.
Ultrasound imaging of uterus demonstrating a Figure 2. Figure 3. Microscopic section of polyp from case 1. Figure 4. Figure 5. Figure 6. Microscopic section of polyp from case 2. Busan, Republic of Korea [ 7 ] 58 7. Table 1. Summary of reported cases of giant endometrial polyps. References A. Bozkurt, D. Kara, and B. Lee, A. Kaunitz, L. Sanchez-Ramos, and R. Wang, J. Zhao, and J. Papadia, D.
But even with the low risk, health care providers often will take a tissue sample of a uterine polyp for lab testing. In some cases, small uterine polyps may go away on their own. If you notice symptoms that could be related to the polyps, make an appointment to see your health care provider promptly. The most common symptom of uterine polyps is abnormal vaginal bleeding , including unusually heavy periods, frequent or unpredictable periods, bleeding between periods, or vaginal bleeding after menopause.
If you are advised that the polyps should be removed, have a conversation with your health care provider about which approach is right for you.
This enables your doctor to see into the uterus and identify the polyps. Your doctor then inserts surgical instruments through the hysteroscope to remove the polyps. On pathology review, Among premenopausal women the risk of cancer or atypical hyperplasia was 0. In postmenopausal women cancer or atypical hyperplasia was found in 1.
Conclusions: The risk of endometrial cancer in women with endometrial polyps is 1. The risk is greatest in postmenopausal women with vaginal bleeding.
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