Uterine Polyps

Uterine polyps, also called endometrial polyps,are bulges or
overgrowth of the inner lining of the uterus protruding into the uterine
cavity from an attachment to the inner wall.

Normally, these polyps contain normal uterine endometrial cells that
have overgrown and bulged into the uterus as a benign( non-cancerous)
growth.

They may be attached to the uterus in two different ways-
either by a broad base ( sessile polyps) or a long stalk like a
lollipop( pedunculated polyps). Pedunculated polyps are more common and
may protrude from the uterine cavity into the vagina. Polyps may also be
found in the uterine cervix. They may range from a few millimeters to
several centimeters, as large as a lawn tennis ball.

An individual
woman may have one or multiple polyps at the same time. Polyps are not
fibroids. While polyps develop from the endometrium, fibroids are benign
tumors of the smooth muscle wall of the uterus.

Causes Of Polyps

No definitive cause of uterine polyps has been established as yet.
However, it is known that estrogen may play a role as many of the polyps
are estrogen-sensitive. That is expected in some way since these polyps
develop from the endometrium in the first place which is also very
sensitive to estrogen.

Polyps often affects women in their 40s or 50s. Both premenopause and postmenopausal women can be affected.

Some few risk factors have been identified which may make a woman more likely to develop polyps including

• Obesity
• Medications like tamoxifen
• High blood pressure

Symptoms

Many polyps will not produce any symptoms.When symptoms develop, they
are often related to bleeding from the blood vessels of the polyp.

Common symptoms include

• Irregular menstrual bleeding — for example, having frequent, unpredictable periods of variable length and heaviness
• Bleeding between menstrual periods
• Spotting before periods
• Heavy menstruation
• Vaginal bleeding after menopause
• Infertility

Diagnosis

Uterine polyps require clinical examination and some investigations
to confirm the diagnosis. Most often, it is necessary to make sure there
is no cancer present.

The tests that are done to diagnose polyps include

• Transvaginal ultrasound. This uses ultrasound probes to visualize the uterus. If can often
  identify the polyp. Saline( sodium chloride water) can be infused into
  the uterine cavity to improve visibility( hysterosonography).
• Hysteroscopy.
  This uses a thin tube with a telescope in it to directly visualize the
  uterine cavity. Sometimes, the polyp seen can be removed during the
  same procedure.Dilatation and Curettage( D & C)The
  cervix is dilated and the endometrium scrapped off using a currette.
  This may remove all small polyps though large ones might be missed.
• Pathology examination. Pathology examination examines the mass to ensure that it is not cancer.

Treatment

The specific treatment will depend on several factors including the
size the polyp, the presence of symptoms or the likelihood of it being
cancerous. One common problem with polyp treatment is recurrence which
will require repeat treatment.

Therapeutic options include

• No treatment.
  Sometimes, the best treatment is no treatment! Nothing needs to be
  done. Your doctor will suggest you simply observe and wait if the polyp
  is small, found incidentally with no symptoms etc. Some small polyps may
  never produce any problems while others may regress on their own
  without treatment.
• Medical therapy.
  Since polyps are sensitive to hormones, hormonal therapy may be used to
  cause the polyp to shrink. Such hormones include progestins and
  gonadotropin-releasing hormone agonists.
• Dilatation and Curettage( D & C). It may be done with the help of the hysteroscope for direct visualization of the polyp or it could be a blind D & C.
• Surgical removal. This is often done with the hysteroscope with instruments sent into the uterus to remove the polyp.
• Hysterectomy.This is reserved for cases where there is high suspicion or confirmed cancer of the endometrium. The entire uterus is remove.

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