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The lining of the womb changes in thickness with each period because of the female hormones. There can be areas that do not react to this normal cycle. These areas form thick knobs, called polyps, that continue to grow.
If a woman does not become pregnant, the endometrial lining sheds, causing a menstrual period. After a period, the lining grows rapidly under the influence of hormones such as estrogen. Polyps are areas that grow a little too much. As they grow, they usually fan out but remain attached to a small stalk, almost like a tree. The stalk is like the trunk of a tree, while the larger part of the polyp is like the branches. They are usually about the size of a pencil eraser, although they can be even smaller. Rarely, polyps can grow as large as an orange.
Signs & Symptoms
When polyps are small, they do not cause problems. As they grow bigger, they can push through the opening of the womb and cause bleeding and cramping.
When symptoms do occur, they usually include excessive bleeding during a menstrual period, or bleeding in between periods, or even spotting after intercourse. Some women report a few days of brown blood after a normal menstrual period. Polyps cause these symptoms because they dangle from their stalks and irritate the surrounding tissue, which causes tissue to rub off, exposing tiny blood vessels. These blood vessels bleed, leading to spotting or vaginal bleeding.
Diagnosis & Tests
Diagnosing endometrial polyps involves looking inside the uterine cavity. A regular ultrasound (also called a sonogram) usually does not diagnose polyps, because the pressure inside the uterus flattens the polyps, making them very hard to see. A special ultrasound, called a sonohysterogram (water ultrasound), allows doctors to see inside the uterus after a few drops of sterile water is carefully infused into the uterus through the vagina. The water opens the uterine cavity, allowing the doctor to see if any polyps are present.
Another diagnostic test is a hysterosalpingogram (HSG), which uses dye under pressure to open the uterus and tubes. A quick X-ray is then taken to see if any polyps are in the uterus. Finally, gynecologists are becoming more skilled at using the hysteroscope to look inside the uterus. This is a small, lighted tube that goes into the vagina then the uterus, to look around inside the uterus. Hysteroscopy using small tubes can be performed in the office, but larger tubes (used to remove large polyps or fibroids) usually require anesthesia in the hospital.
Treatment & Prevention
The old-fashioned way was to perform a D&C (dilatation and curettage). This involves a gentle scraping of the uterine lining. Unfortunately, this may miss the polyp completely, since this procedure is done solely by feel. As the scraping instrument goes by, it will likely just push the polyp out of the way without grabbing it.
Hysteroscopes now allow us to look right at the polyp as we grasp it or cut it away from the uterine lining. This ensures that the polyp (or, in some cases, multiple polyps) is removed.
Prognosis; Complications
Rarely, once the growths are removed, they may return -- this usually occurs years later, if at all. Most polyps grow very slowly. Rarely is major surgery needed for polyps, unless they are found to be precancerous or cancerous.
In some women, if the polyp(s) interfere with the egg and sperm, it may make it hard to get pregnant. It is unknown at the time of writing how common this is. It is also possible that they may lead to a slightly higher chance of miscarriage, but this is also unknown. Most gynecologists will remove polyps if they are found in women with a history of miscarriage.
If a polyp is diagnosed one of the first questions is, "Could this be cancer?" Although some polyps are thought to turn gradually into cancer, fortunately they rarely do. The risk does increase slightly as a patient passes age 50: polyps that appear during menopause may put the woman at greater risk. Usually, postmenopausal bleeding caused by the polyps will warn women to seek care.
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Conditions that suggest Endometrial Polyps:
Risk factors for Endometrial Polyps:
Endometrial Polyps can lead to:
KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Very strongly or absolutely counter-indicative |
GLOSSARY
Anesthesia
Loss of sensation caused by neurological dysfunction or a pharmacological depression of nerve function.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Dilatation
Normal increase in the size of a body opening, blood vessel, or tube.
Dilation and Curettage (D&C)
The scraping of the lining of the uterus (the endometrium). There are two main reasons for performing a D&C: to remove tissue remaining in the womb in a recently pregnant woman, and as part of the investigation of a woman who is experiencing heavy or irregular periods or vaginal bleeding after menopause.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Leiomyomas (Fibroids, Fibromyoma, Leiomyoma, Myofibroma)
Benign tumors of the involuntary muscle. An encapsulated tumor made up of disorganized and irregular connective tissue. The most common of these is the "fibroid" tumor that develops in many women. It is really a leiomyoma of the uterus.
Malignant (Cancerous)
Dangerous. Mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Miscarriage (Miscarriages, Spontaneous Abortion)
The expulsion of a fetus before it is able to survive outside of the womb.
Polyp (Polyps)
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Postmenopause (Postmenopausal)
The postmenopausal phase of a woman's life begins when 12 full months have passed since the last menstrual period and any menopausal symptoms have become milder and/or less frequent.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Nov 08, 2009
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