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DRCOG MCQs for Circuit A Questions
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Differential diagnosis for postmenopausal bleeding includes: Carcinoma of the cervix.Adenomyosis.Endometrial polyp.Atrophic vaginitis.Endometrial carcinoma.
Acquired uterine conditions, reproductive surgery, and recurrent implantation failure
Published in Efstratios M. Kolibianakis, Christos A. Venetis, Recurrent Implantation Failure, 2019
Dimitra Aivazi, Eleni Tsakalidou, Grigoris F. Grimbizis
Due to the lack of high-quality prospective studies in the field of IVF in women with endometrial polyps, the hypothesis of their unfavorable effect on implantation is currently based on studies comparing IVF outcome in patients with and without polyps. Tiras et al.52 studied IVF patients with untreated endometrial polyps <14 mm diagnosed during ovarian stimulation and a control group of IVF patients with normal cavity; they found similar pregnancy rates in both groups, suggesting that the presence of polyps does not affect implantation. On the other hand, Yang et al.53 compared IVF patients with endometrial polyps diagnosed incidentally during ovarian stimulation with age-matched IVF patients having normal cavity. They observed significantly higher clinical pregnancy rates after hysteroscopic polypectomy followed by frozen embryo transfer than in normal controls followed by fresh embryo transfer (63% vs. 41%, p = 0.009), indicating that the presence of polyps interferes with the achievement of pregnancy and potentially implantation despite the obvious bias in the embryo transfer policy. Furthermore, the achievement of pregnancy was similar 1–3 months postpolypectomy. Elias et al.,54 although they failed to find any difference between IVF patients having polyps compared to those with normal cavity, observed significantly higher biochemical pregnancy rates indicating that polyps could interfere with the evolution of pregnancy.
Conditions
Published in Sarah Bekaert, Women's Health, 2018
Endometrial polyps are localised overgrowths of the endometrium that project into the uterine cavity. Such polyps may be sessile (broad-based) or pedunculate, and very occasionally include areas of benign or malignant growth. Endometrial polyps are estimated to occur in 10-24% of women undergoing hysterectomy or localised endometrial biopsy. Endometrial polyps are rare among women under 20 years of age. The incidence of these polyps rises steadily with increasing age, peaks in the fifth decade of life, and declines after the menopause.
Retrospective analysis of the endometrial preparation protocols for frozen-thawed embryo transfers in women with endometrial polyps
Published in Human Fertility, 2022
Zengyan Wang, Yangxing Wen, Yujing Xiong, Yubin Li, Jia Huang, Yanwen Xu
In the women in this study, the endometrial polyps were found during IVF stimulation. We adopted the freeze-all strategy and hysteroscopic polypectomy and then selected the endometrial preparation schemes for the FET cycle. It was not feasible to use oral contraceptives or P in the endometrial preparation scheme for FET. The GnRHa-HRT regimen inhibits the hypothalamus-pituitary-ovary axis, thereby causing a low oestrogen state. Endometrial polyps are oestrogen-dependent diseases, and low oestrogen levels can reduce risk. In a low oestrogen state, appropriate amounts of exogenous oestrogen can promote endometrial growth. Therefore, it can not only promote the growth of the endometrial membrane to accept embryo implantation, it can also prevent the growth of endometrial polyps. Some studies suggest that the recurrence of endometrial polyps is associated with changes in growth factors, such as the vascular endothelial growth factor (Xuebing et al., 2011). Further studies on the changes in growth factors in the GnRHa-HRT regimen and the mechanism of reducing the recurrence of endometrial polyps are warranted.
Effectiveness of different methods for polypectomy in the menopause: a retrospective study
Published in Climacteric, 2020
S. Molnár, Z. Farkas, A. Jakab, R. Lampé, P. Török
The endometrial polyp is a common lesion in both women’s reproductive and postmenopausal ages; it is a localized tumor in the uterine cavity, which represents focal hyperplasia of the basal layer of the endometrium1. Histologically, the endometrial polyp is composed of endometrial glands and stroma around a vascular axis of spiral arteries. The pathogenesis of polyps is not exactly clear; according to Baiocchi et al., it is similar to that of endometrial hyperplasia2. There are changes in the hormonal responsiveness of endometrial tissue with the increase of estrogen receptors and the decrease or disappearance of progesterone receptors, leading to unopposed estrogen stimulation3. Similarly, hormonal disorders such as chronic anovulation, luteal insufficiency, or hyperestrogenic states may cause the formation of endometrial polyps2,4. Polyps may be single or multiple, of various sizes, sessile, or pedunculated1.
Clinical management of vaginal bleeding in postmenopausal women
Published in Climacteric, 2020
Endometrial polyps are a common cause of PMB. The vast majority of endometrial polyps are benign, but the prevalence of malignancy within the polyps ranges between 1.5 and 12.9%50,51. The risk of endometrial hyperplasia and cancer in polyps is 4.4-fold higher in postmenopausal patients with PMB compared to asymptomatic women. Ghoubara et al. evaluated 421 women with endometrial polyps in a cohort of 2625 patients with PMB. The prevalence of hyperplasia or cancer was 8%, with a 5.5-fold increased risk in those with endometrial thickness greater than 10 mm and a 3.5-fold increased risk in those with body mass index >32.5 kg/m2. It was concluded that the prevalence of endometrial cancer in polyps is high when causing bleeding during menopause, recommending removal of all polyps in postmenopausal patients presenting with PMB50,51. A recent systematic review including 51 studies with over 35,000 patients reported a prevalence of malignant polyps in postmenopausal women of 4.93%, with a higher risk of malignancy if having bleeding (5.14% vs. 1.89%, p < 0.0001). The authors concluded that expectant management in symptomatic patients should be discouraged; however, the final decision should be individualized based on the overall risk profile and patient desire52.