Какво правят жените в менопауза, когато ... 6

Тоест, ако няма кървене няма повод за притеснение, така ли да те разбирам? Извини ме, ако ти звуча тъпичко, но не съм наясно.

Принципно, да, ако нямаш кръвене, няма причина да си мислиш, че имаш полип и да търчиш по хистероскопии.

Благодаря ти.

Както Ви обещах пиша какво ми каза днес докторката .
На ехографа не се вижда полип ,лигавица нормална ,цитонамазка добра ,но лекото зацапване днес го няма .
Според нея трябвало непременно да се вземе проба и да се изследва .Нейното мнение съвпадна с др.мнение на другия лекар 
Към всички: тази при която днес бях ,дори и да няма други доктори НЕ бих отишла Никога !!!
Толкова груба относно прегледа говоря ,не бях виждала !Била добра ,няма нужда има и по-добри ,а не грубияни като нея !
Миналия път при мъж бях ,ами не беше толкова груб .
Нямам думи ,такъв ужас ,такова нещо !Без думи съм !

Шарки, иска регистрация.Може ли да копираш текста и да го сложиш скрит тук?

Странно, през деня се четеше без проблем, сега иска логини.

Risk of Malignancy in Endometrial Polyps in Premenopausal and Postmenopausal Women According to Clinicopathologic Characteristics

Costa-Paiva, Lucia MD, PhD; Godoy, Carlos E. Jr MD; Antunes, Armando Jr MD; Caseiro, Joyce D. MD; Arthuso, Michael MD; Pinto-Neto, Aarao M. MD, PhD
DISCLOSURES Menopause. 2011;18(12):1278-1282.

Abstract and Introduction

Abstract
Objective: The aim of this study was to evaluate the prevalence of endometrial premalignant and malignant polyps in premenopausal and postmenopausal women, as well as the clinical, ultrasound, and hysteroscopic factors associated with malignancy.
Methods: All women undergoing hysteroscopic resection of endometrial polyps from January 1998 to December 2008 were selected using a computerized database from the operating theater of the Prof. Dr. José Aristodemo Pinotti Women's Hospital, Women's Health Care Center/University of Campinas. Eight hundred seventy women with ages ranging from 25 to 85 years were included. Polyps were classified into benign (endometrial polyps and polyps with nonatypical simple hyperplasia and nonatypical complex hyperplasia), premalignant (polyps with atypical simple hyperplasia or atypical complex hyperplasia), and malignant. Statistical analysis was performed by measurement of the frequencies, means, and SD. The risk factors for malignancy were assessed by bivariate and multiple regression analyses, using the Epi-Info 2000 program and SAS (Statistical Analysis Software), version 9.2.
Results: The mean (SD) age of the women was 57.5 (10.6) years. Of these women, 76.4% were postmenopausal. Women were diagnosed with benign lesions in 95.8% of cases. Premalignant polyps accounted for 1.6% of the total number of cases. Malignant polyps represented 2.5% of the total sample. Postmenopausal bleeding and age greater than 60 years were the only factors that remained associated with a higher risk of malignancy with a prevalence ratio of 3.67 (95% CI, 1.69–7.97) and 1.5 (95% CI, 1.01–1.09), respectively.
Conclusions: The prevalence rate of malignancy in endometrial polyps was higher in women with postmenopausal bleeding and advanced age.
Introduction
With the increased use of ultrasound, hysterosonography, and hysteroscopy in the evaluation of women with abnormal uterine bleeding or postmenopausal bleeding, the diagnosis of endometrial polyps has become more frequent in the last few years. The prevalence rate of endometrial polyps ranges from 10% to 40%[1–5] in women with abnormal uterine bleeding, and polyps are found in up to 12% of asymptomatic women in routine examinations.[6,7]
Endometrial polyps are defined as overgrowths of localized endometrial tissue. Polyps may be pedunculated or sessile, or single or multiple, ranging in size from a few millimeters to many centimeters. These lesions may contain varying amounts of stroma and blood vessels, covered by pseudostratified epithelium.[8]
It is well known that the prevalence rate of malignancy associated with endometrial polyps ranges from 0.8% to 8%, depending on the sample analyzed and the resection methods used.[9–16]
Previous studies have demonstrated a significant increase in the incidence of premalignant and malignant polyps in postmenopausal women older than 60 years who have associated vaginal bleeding[10,17] Some studies have also observed an association with other risk factors for malignancy such as obesity, use of tamoxifen, arterial hypertension, and diabetes mellitus.[18]
Hysteroscopy is considered the gold standard in the resection of endometrial polyps and evaluation of the endometrial cavity, allowing complete removal of the lesion and biopsy of suspicious areas in the adjacent endometrium.[11] This method has a sensitivity of 97% and a specificity of 90% for the diagnosis of endometrial polyps, using histologic diagnosis of the biopsy as the gold standard. It surpasses exclusive use of ultrasound evaluation, with values of 41% and 83%, respectively.[19]

Despite the low prevalence rate of malignancy, various women have undergone surgical procedures for the removal of polyps without a precise indication. Thus, it is imperative to determine which women are at greater risk so that a more judicious surgical indication for hysteroscopic resection of endometrial polyps can be made.
The aim of the study was to determine the prevalence of premalignant and malignant endometrial polyps in premenopausal and postmenopausal women. All women evaluated in this study underwent hysteroscopic resection of endometrial polyps and comprise one of the largest case studies investigating the topic in the literature. Furthermore, associations between clinical, ultrasound, and hysteroscopic factors as well as the risk of malignancy were evaluated.

Methods

This study was conducted in the Prof. Dr. José Aristodemo Pinotti Women's Hospital, Women's Health Care Center/University of Campinas (UNICAMP), and was approved by the research ethics committee of the UNICAMP Medical School under number 769/2009. According to the information contained in the computerized database of this institution, 6,018 surgical hysteroscopies were performed in this service from January 1998 to December 2008, for the diagnosis and treatment of diverse uterine conditions. Of the women examined, 1,050 underwent surgical treatment of endometrial polyps.
Eight hundred seventy women were included in the study, with ages ranging from 25 to 85 years. These women were grouped according to menopause status: premenopausal or postmenopausal. Menopause was considered amenorrhea lasting more than 12 months. Women included in the study had a previous diagnosis of endometrial polyp by ultrasound or diagnostic hysteroscopy. Excluded from the sample were women in whom resection of the lesion was not possible or there was no histologic confirmation of endometrial polyp.
Clinical, pathologic anatomy, ultrasound, and hysteroscopic data were obtained by reviewing medical charts. A chart elaborated as an instrument for data collection was used. Clinical variables assessed were age, postmenopausal bleeding, time since menopause, parity, arterial hypertension, obesity, diabetes mellitus, use of hormone therapy, and use of tamoxifen.
A diagnosis of endometrial polyp by ultrasound was made following a finding of focal endometrial thickening, associated with the presence of vascular pediculum. Diagnostic hysteroscopy was performed by using a 2.8-mm optical system (Karl Storz, Tuttlingen, Germany). For distension of the uterine cavity, CO2 and saline infusion were used. Evaluation of the endocervical canal, endometrial surface, vascularity, tubal ostia, endometrial polyps, myomas, or synechiae was performed.
Surgical hysteroscopy was performed by a gynecologist with the patient under spinal anesthesia. A 10-mm resectoscope was used for the surgical procedure (Karl Storz). Distension of the uterine cavity was obtained by use of 1.5% glycine solution. The endocervical channel and endometrial cavity were evaluated. Resection of endometrial polyps was performed by electrocautery using monopolar energy.
Pathologists from the Department of Pathological Anatomy of the UNICAMP Medical School analyzed the endometrial samples obtained, using hematoxylin and eosin staining. Polyps were classified as benign, nonatypical simple hyperplasia, nonatypical complex hyperplasia, atypical simple hyperplasia, atypical complex hyperplasia, and malignant.

Следва стаистически анализ и таблици, и след това
Discussion

We evaluated the prevalence of premalignant and malignant endometrial polyps, as well as the factors associated with malignancy, in a large case study consisting of women undergoing polypectomy by hysteroscopy. The results showed that the prevalence of premalignant and malignant polyps was low. Furthermore, it was associated with the presence of postmenopausal bleeding and advancing age. Most women were older than 50 years, were postmenopausal, and had comorbidities.
The prevalence rate of premalignant and malignant polyps was 4.1%. A previous study conducted by our group, with 50% of the case study, showed a prevalence rate of 3.8%.[10] These findings are similar to those of other studies showing a prevalence rate of malignancy in endometrial polyps ranging from 0.8% to 8%.[1,9,11,13,14,16] These differences in prevalence rates observed may be attributed to different study designs, sample sizes, inclusion and exclusion criteria, and different methods used for the diagnosis of polyps, such as transvaginal ultrasound, hysterosonography, and hysteroscopy.[19]
In a recent meta-analysis published by Lee et al,[20] including 17 studies with a total number of 10,572 premenopausal and postmenopausal women, the prevalence rate of premalignancy and malignancy was 3.57%. In this study, cases of atypical endometrial hyperplasia and endometrial carcinoma were grouped together. These two cases were grouped together because atypical polyps have an elevated rate of malignant transformation (up to 28% of cases). In addition, when hysterectomy is performed, it is well known that endometrial carcinoma is diagnosed in up to 42.6% of women with premalignant endometrial polyps.[21]
In our case study, the presence of postmenopausal bleeding was the main risk factor for malignancy. Women with postmenopausal bleeding had a 3.73-fold higher risk of developing malignancy than did asymptomatic women. This association has also been reported in most studies in the literature.
In a meta-analysis, 4.15% of women with abnormal uterine bleeding had endometrial polyps, with a PR of 1.97 (95% CI, 1.24–3.14). Among asymptomatic women, the prevalence rate of endometrial polyps was only 2.16%. Considering women with postmenopausal bleeding and endometrial polyps, the prevalence rate of malignancy was 4.47%, in comparison with 1.51% among asymptomatic women, with a PR of 3.36 (95% CI, 1.45–7.80).
Regarding menopause status, despite a higher prevalence of malignancy in postmenopausal women compared with premenopausal women (4.67% vs 1.95%), we did not observe a significant association (P = 0.08) and only noted a statistical trend (PR, 2.40; 95% CI, 0.86–6.71). Of the 17 studies included in the meta-analysis, 12 revealed an increased risk of malignancy in postmenopausal women, with a relative risk of 3.86 (2.93–5.11).[20]
Age was a risk factor for malignancy in our study. The prevalence rates of malignant polyps were 3.7% in women younger than 40 years, 3.11% in women aged between 40 and 59 years, and 5.36% in women older than 60 years. On multiple regression analysis, the PR for malignancy was 1.05 (95% CI, 1.01–1.09). In a research study conducted by Antunes et al[10] with 475 participants older than 40 years, the PR in the group of women older than 60 years was 4.71 (95% CI, 1.08–20.56), compared with that in women aged 40 to 59 years. The distinct relative risks found among studies with different case studies may be attributed to the higher prevalence of malignant endometrial polyps diagnosed in women younger than 60 years in the study of Antunes et al.[10]

The presence of obesity (BMI >30 kg/m2) was also associated with malignancy in endometrial polyps. Obese women have higher concentrations of serum estrogen, leading to a greater stimulation of endometrial proliferation. As a consequence, there is the appearance of benign endometrial polyps and premalignant or malignant lesions.[22]
Hypertension has been recognized as a risk factor for hormone-dependent neoplasms in women because it promotes a decrease in the mechanisms of cell apoptosis, favoring tumor growth.[23] In the present study, we identified a trend toward a higher risk of malignancy in hypertensive women. In a meta-analysis by Lee et al,[20] only studies by Savelli et al[11] and Baiocchi et al[13] reported a significant association between arterial hypertension and the presence of malignant endometrial polyps.
Diabetes mellitus is related to an increased risk of malignant endometrial neoplasms, due to cellular alterations mediated by insulinlike growth factor in states of hyperinsulinemia.[24] A correlation between diabetes mellitus and malignant endometrial polyps has been studied by various authors. This association was only present in a study carried out by Gregoriou et al.[22] In our study, there was no significant association between these two variables. Similar to the findings observed by other authors, the risk of premalignant or malignant lesions in endometrial polyps was not shown to be influenced by parity, use of hormone therapy, and use of tamoxifen.[10,11,13]
Concerning polyp size, the prevalence rate of malignancy in lesions larger than 15 mm was 5.06% compared with 2.09% in polyps of a smaller diameter. No significant association has been observed, only a statistical trend, with a PR of 2.41 (95% CI, 0.98–5.93). Few studies have evaluated the relationship between polyp size and malignancy risk. Some authors have suggested that larger polyps are associated with a higher risk of malignancy.[14–16] According to Goldstein et al,[3] Gregoriou et al,[22] Fernandez-Parra et al,[25] and Shushan et al,[26] polyp size does not represent a risk factor for malignancy. In a meta-analysis, polyps are reported by different units of measurement (centimeters, millimeters, or grams), making the analysis of this association more difficult.
One limitation of this study was data collection. The data were collected exclusively from medical charts that may be responsible for incomplete or inconsistent information. However, it is worth mentioning that this study was conducted with a large sample size using surgical hysteroscopy. This technique permits direct removal of the lesion, reducing the possibility of a misdiagnosis. Furthermore, the prevalence of premalignant and malignant polyps can be more adequately estimated. Despite the large total sample size, the final results should be interpreted with caution. The reason is that fewer cases in each subgroup could interfere with the results for the analysis of isolated risk factors.

Conclusions

From the results of this study, we conclude that women with endometrial polyps and postmenopausal bleeding had a higher prevalence of endometrial malignancy. These cross-sectional results suggest that women presenting with these risk factors should undergo hysteroscopic resection of lesions. Because of the low prevalence rate of malignancy in asymptomatic young women with no risk factors, routine removal of the lesions might be avoided because of its lack of cost-effectiveness. It is important to emphasize the need for prospective studies of long-term outcomes in women diagnosed with endometrial polyps to confirm these results and establish clinical recommendations. Nevertheless, it is important to highlight that these women will require a stricter follow-up period because premalignant or malignant lesions may be found even in the absence of these factors.

Шарки БЛАГОДАРЯ ТИ !!!
При следващата почивка съм при доктора за да ми направи това абразио и да се вземе материал 
Явно без това няма да стане .
Оф, много ме е страх ,а и да не изключваме и колко е неприятно упойки и т.н.
Ако някой е минал по този път моляяяя ,да ми пише на лични да знам какво ме очаква 
Много благодаря на Шарки още веднъж от сърце ,че сподели тази статия !!!

Биопсия, не абразио, биопсията се прави без упойка и да си кажа, издържа се, не е чак кой знае колко болезнена (като болка при по-тежък цикъл). На мен ми я правиха по време на инвитро опитите.

Ами на мен ми казаха с пълна упойка ,но без тръба в гърлото .
Уж,бързо ставало и след два часа си тръгваш
Ужас ,как си го казват все едно е нищо ,а то си е пълна упойка .

Е нали няма да те интубират, просто ще заспиш по-дъблоко. Различно е.

Краткотрайна венозна е упойката, след това половин час си ужасно приказлива и нахилена, направо купон    До час-два си си ОК, но след като мине еуфорията си поспалива.

Много благодаря!
Дано всичко да е ок за резултатите! 🍀
На др.ден трябва да съм на работа.
А колко време след това има кървене?
След колко време излизат резултатите?
Извинявам се за всичките въпроси и благодаря за отделеното време за отговор 💐!

1-3 дена кървене (при мен, поне) и стандартните, мисля,  1 седмица, за хистологията. На следващия  ден след манипулацията  си бях на работа.

Много благодаря !