Endometrial Polyps

Endometrial Polyps: Overview

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 estrogenPolyps 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 and 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 and 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 and 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.

Conditions that suggest Endometrial Polyps:

Reproductive

Risk factors for Endometrial Polyps:

Medical Procedures

Counter-indicators

Endometrial Polyps suggests the following may be present:

Tumors, Benign

Endometrial Polyps can lead to:

Reproductive

KEY

Weak or unproven link: may suggest
Weak or unproven link:
may suggest
Strong or generally accepted link: often leads to
Strong or generally accepted link:
often leads to
Definite or direct link: suggests
Definite or direct link:
suggests
Definitely or absolutely counter-indicates: decreases risk of
Definitely or absolutely counter-indicates:
decreases risk of