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.