Uterine polyps are growths that develop in the lining of the uterus, known as the endometrium. These polyps are formed when the endometrial tissue grows excessively, attaching to the uterine lining either by a thin stalk or a broad base, and they can extend into the uterus. They can be round or oval, with sizes ranging from as small as a sesame seed to as large as a golf ball, or even bigger.
While uterine polyps are generally noncancerous, they can lead to complications such as irregular menstrual periods or issues with fertility. The presence of one or more polyps may cause symptoms or contribute to difficulties in conception.
DIFFERENT TYPES OF UTERINE POLYPS
Some endometrial polyps exhibit unique characteristics when observed under a microscope, leading to their classification as variants. These variants often have specific names that may appear in medical reports. Here are some common types:
- Endometrial polyp with gland crowding: In this variant, the glands within the polyp are more densely packed than normal. This condition might necessitate further medical evaluation and re-sampling of the endometrium to rule out endometrial hyperplasia, a condition involving abnormal thickening of the uterine lining.
- Adenomyomatous polyp: This type of polyp contains smooth muscle cells in addition to the usual endometrial glands and stroma. It is benign, meaning it is non-cancerous.
- Mixed polyp: This polyp consists of tissues from both the endometrium and the endocervix, the lower part of the uterus. As a result, it exhibits features of both an endometrial polyp and an endocervical polyp.
CAUSES OF UTERINE POLYPS
The growth and development of the normal endometrium are controlled by hormones such as estrogen. High levels of estrogen can cause increased growth of the tissue in the endometrium and over time the development of an endometrial polyp. Other associated conditions include high blood pressure, obesity, late menopause, and tamoxifen treatment.
SYMPTOMS
The presence of uterine endometrial polyp can bring about different symptoms, which may vary in intensity from woman to woman. Common symptoms include:
- Abnormal Uterine Bleeding: One of the most common signs of uterine polyps is abnormal uterine bleeding. This can manifest as unusually heavy periods, prolonged bleeding, or spotting between periods. Postmenopausal bleeding can also indicate the presence of polyps and should be promptly evaluated.
- Irregular Menstrual Cycles: Period irregularities can result from uterine polyps disrupting the typical menstrual cycle. Menstrual bleeding changes in duration, frequency, or flow may be a sign of polyps.
- Pelvic Pain and Discomfort: Pelvic pain and discomfort can fluctuate in intensity in women with uterine polyps and can be modest to severe. The lower abdomen or pelvis may be the site of the discomfort, which may be ongoing or sporadic.
- Infertility and Pregnancy Complications: Fertility problems may result from uterine polyps that change the uterus’s size, shape, or other physical characteristics. The presence of polyps may prevent a fertilised egg from implanting properly or increase the chance of miscarriage.
DIAGNOSIS
Here are some common procedures used to diagnose and treat uterine polyps:
- Transvaginal Ultrasound: In this procedure, your doctor inserts a slender, wand-like device into your vagina. This device emits sound waves that create images of the inside of your uterus, helping to detect polyps.
- Hysterosonography or Sonohysterography: This technique is often used alongside a transvaginal ultrasound. A thin tube (catheter) is inserted into your vagina to inject saline solution into your uterus. The saline expands the uterus, providing a clearer image during the ultrasound.
- Hysteroscopy: A thin, flexible, lighted instrument called a hysteroscope is inserted through your vagina and cervix into your uterus. This allows the doctor to directly view the lining of your uterus. If polyps are found, they can be removed during the same procedure.
- Endometrial Biopsy: A soft plastic instrument is used to take a small sample of tissue from the uterine lining. This sample, or biopsy, is sent to a lab for analysis to check for the presence of cancerous cells.
- Curettage: Performed in an operating room, this procedure involves using a metal instrument with a small loop at one end, called a curette, to scrape tissue or polyps from the uterus for examination. The curette can also be used to remove polyps.
HOW IS UTERINE POLYPS AND INFERTILITY LINKED?
Infertility is generally defined as the inability to conceive after a year of trying. Research has shown that during hysteroscopy before in vitro fertilization (IVF), unexpected intrauterine abnormalities are detected in 11% to 45% of cases. When a person is experiencing abnormal vaginal bleeding, the likelihood of uterine polyps being present increases.
Uterine polyps can interfere with fertility in several ways. They may prevent a fertilized egg from implanting in the uterine wall, or they could obstruct the area where the fallopian tube connects to the uterine cavity, making it difficult for sperm to reach the egg. Polyps can also block the cervical canal, preventing sperm from entering the uterus altogether. Additionally, in some cases, polyps may contribute to miscarriage.
TREATMENT
The approach to treating uterine polyps depends on the symptoms and any factors that may increase the risk of uterine cancer. If you’re still of reproductive age and the polyp isn’t causing any symptoms, your healthcare provider may opt to monitor it, as the polyp might resolve on its own. However, if you’ve gone through menopause or if the polyps are causing symptoms, treatment may be necessary.
Treatment options include:
- Medications: Hormonal treatments, such as progestins or gonadotropin-releasing hormone agonists, can help alleviate symptoms by keeping your hormones balanced. However, symptoms may return once the medication is stopped.
- Uterine Polypectomy: During a hysteroscopy, your healthcare provider can often remove the polyp. Using a hysteroscope, they can insert instruments to precisely excise and remove the polyp. The removed tissue is usually sent to a lab to check for cancer.
If the polyp is found to be cancerous, additional surgery may be required. In some cases, a hysterectomy, which involves removing the uterus, might be necessary if cancer cells are present in the polyps.
WHAT PERCENTAGE OF UTERINE POLYPS ARE CANCEROUS?
Approximately 5% of uterine polyps are cancerous. The risk of a polyp being cancerous increases if you are postmenopausal or experiencing abnormal bleeding. Sometimes, a benign polyp may appear similar to uterine cancer, such as endometrial sarcomas, or precancerous conditions like endometrial hyperplasia. If there’s any uncertainty, your healthcare provider can perform a biopsy on the tissue to rule out the possibility of cancer.
DO UTERINE POLYPS NEED TO BE REMOVED?
The decision to remove a uterine polyp depends on several factors. If you are premenopausal and not experiencing any symptoms, the polyp is generally considered low risk and may not require removal. However, if you are postmenopausal or experiencing symptoms such as abnormal bleeding, your healthcare provider may recommend removing the polyp. Additionally, polyps may be removed if they are likely to cause complications during pregnancy or could potentially affect fertility.
UTERINE POLYPS VS. FIBROIDS
Polyps and fibroids are related but distinct conditions. Fibroids are tumors that develop from the muscular tissue of the uterine wall, while polyps arise from the lining of the uterus. Both can lead to heavy bleeding, but fibroids may also cause additional symptoms such as pelvic pain, constipation, and urinary difficulties. Diagnostic tests can identify both conditions, allowing your doctor to determine which one you have and to suggest the most appropriate treatment.
CONCLUSION
Uterine polyps are a common and treatable condition. By understanding the causes, symptoms, diagnosis, treatment, and complications associated with uterine polyps, women can take control of their reproductive health. Early diagnosis and treatment are essential to prevent complications and improve quality of life. Let us work together to raise awareness and promote education about uterine polyps, ensuring that women receive the care they deserve.
