Uterine Polyps

Uterine polyps at a glance

• Uterine polyps, also known as endometrial polyps, are bulb-shaped growths of endometrial tissue that develop in the uterus, attaching to the uterine lining by a stalk.
• Polyps can also develop in the cervix or inside the cervical canal, as well as slip down through the uterus opening into the vagina.
• Polyps are usually noncancerous, but may become cancerous over time.
• The exact cause of these polyps is unknown, but the hormone estrogen seems to promote their growth.
• Uterine polyps are most often seen in women who have gone through menopause, but can develop in younger women, sometimes causing infertility. It is not clear if they cause recurrent miscarriage.
• Polyps often do not show symptoms, but abnormal uterine bleeding is the most common symptom.
• Some polyps do not require treatment; symptomatic polyps can be treated through medication or removal, and do not usually return after treatment.

Causes of these polyps

Uterine (endometrial) polyps are similar to uterine fibroids, most likely developing due to an imbalance of the hormone estrogen. Excess endometrial tissue develops in response to estrogen, causing soft uterine polyps to grow from the uterine lining. Polyps are more frequently seen in perimenopausal or postmenopausal women, but can occur in younger women as well.

Endometrial polyps are more common in women with high blood pressure (hypertension), who are overweight, or who are taking tamoxifen (a medication used for treating breast cancer).

Symptoms of polyps

Many women with polyps do not experience symptoms, but the most common symptoms include:

• Irregular periods or menstrual bleeding
• Heavy menstrual bleeding
• Vaginal bleeding after menopause
• Bleeding between periods
• Bleeding after sex

When these symptoms are severe, the woman should visit her doctor, as these may also indicate endometrial cancer.

These polyps can also cause infertility or, possibly, miscarriages by preventing the fertilized egg from implanting in the uterine wall correctly. Research published by the National Institutes of Health indicates that endometrial (uterine) polyps are a factor in about 35% of female infertility.

Treatment of uterine polyps

Treatment for uterine polyps ranges from observation of the polyps (to make sure they do not develop worrisome features) to surgical removal. Hormonal medication such as progestin may relieve symptoms and shrink the polyp, but symptoms generally return once the medication is stopped.

Surgical treatment

A few minimally invasive surgical techniques can treat polyps in the uterus. The preferred method to treat polyps is hysteroscopy, a surgical procedure in which a tube connected to a camera (hysteroscope) is inserted through the cervix and into the uterus so that the polyp can be visualized directly and removed with precision. This procedure does not involve any incisions and can be completed as an outpatient with minimal recovery time needed.

A physician may also perform cervical dilation and curettage, also known as a D&C, by using a long metal tool to scrape the uterine lining, either to obtain a sample for diagnosis or remove the polyp. A D&C is not the preferred method of treatment, because it is possible to incompletely remove the polyp. Incomplete removal can result in recurrence. In addition, a D&C can create scar tissue within the uterus, which can lead to infertility.

Removed polyps may also be tested for cancer cells to determine if further treatment is necessary. Once removed, polyps generally do not resurface.