Uterine polyps

Uterine polyps are neoplasms attached to the inner wall of the uterus, which covers the entire uterine cavity.

Overgrowth of cells in the lining of the uterus /endometrium/ can lead to the formation of polyps and are also called endometrial polyps.

They are usually non-cancerous /benign/, although some can be malignant or eventually turn into cancer /precancerous polyps/.

Uterine polyps range in size from a few millimeters – no bigger than a sesame seed – to several centimeters the size of a golf ball or larger.

They attach to the uterine wall with a large or small base.

Polyps may be one or several. Usually they are in the uterine cavity, but sometimes they can penetrate through the opening of the uterus /cervix/ into the vagina.

Uterine polyps most often occur in women who are entering the peri- or postmenopausal period, although younger women can also form.

What are the symptoms?

Irregular menstrual bleeding – for example, frequent, unpredictable periods of varying duration and intensity;

• Bleeding between periods;

• Extremely heavy menstrual cycles;

• Vaginal bleeding after menopause;

• Infertility;

Some women may experience only light bleeding or spotting or may even develop clinical symptoms.

When should you seek medical attention?

Seek medical attention if you have:

• Vaginal bleeding after menopause;
• Bleeding between periods;
• Irregular menstrual bleeding;

What are the causes?

Although the cause of endometrial polyps is unknown, hormonal disorders are believed to be among the contributing factors.

Uterine polyps are estrogen sensitive, meaning they respond to estrogen in the same way as the lining of the uterus – they grow in response to increased amounts of estrogen.

Risk factors for the appearance of endometrial polyps are:

• Peri- or postmenopausal age;
• High blood pressure /hypertension/;
• Obesity;
• Use of tamoxifen – medicine for the treatment of breast cancer;

What are the complications?

Endometrial polyps can cause infertility. If you have growths in your uterus and are unable to get pregnant, removing them will likely make conception possible.

Uterine polyps also may pose an increased risk of miscarriage in women undergoing IVF.

If you are considering infertility treatment through assisted reproduction and you have uterine growths, your doctor may recommend removing the polyps before embryo transfer.

Treatment of uterine polyps

• Active surveillance – small polyps that are asymptomatic may resolve on their own. Treatment is not necessary unless the neoplasms are found to be precancerous.

• Medicines – some hormonal medicines such as progestins and gonadotropin-releasing antagonists can help shrink the uterine polyp and reduce symptoms. But taking medication is usually a short-term solution to the problem, and after stopping the medication, the symptoms reappear.

• Curettage or abrasion – a long metal tool is used – a curette with a tip at the end, with which the inner walls of the uterus are scraped. It can be applied to collect material for laboratory tests or to remove polyps. Abrasion can also be performed using a hysteroscope, which allows the surgeon to observe the inside of the uterus before and after the procedure.

Surgical removal – during the hysteroscopy, another instrument is inserted to remove the polyp or polyps.

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