Endometrial Polyps

September 5, 2011

Endometrial polyps are noncancerous (benign) growths found within the uterine cavity. Usually they are asymptomatic and remain undetectable for decades. In women without symptoms, they are often found coincidentally when pelvic ultrasound is performed for unrelated problems. However, in women with abnormal uterine bleeding, investigation of the bleeding may lead to their detection.

The symptoms most often related to uterine polyps include abnormal bleeding, postcoital staining (bleeding after intercourse), chronic vaginal discharge, painful periods (dysmenorrhea), or infertility. Generally, the abnormal bleeding associated with polyps is characterized by: intermenstrual (bleeding between periods) or premenstrual spotting, or heavier menstrual flow, or increased clotting at the time of menses. Additionally, one fourth of women with polyps in the tube leading from the vagina to the uterus (endocervical polyps) will have an endometrial polyp.

Luckily, 99% of polyps removed by hysteroscopy (surgical removal via small tube) are benign (noncancerous). In women who are experiencing symptoms, however, hysteroscopic removal is imperative to evaluate the histology (microscopic evaluation) of the endometrial polyps. Endometrial cancer and excessive growth/numbers of cells of the endometrium (hyperplasia) rarely occur within an endometrial polyp. In fact, only 1% of endometrial polyps may have a coexisting malignancy present. Even though cancer is rarely found within an endometrial polyp, the surgical removal of the polyps in patients who have abnormal bleeding is imperative for two reasons. The first is to treat menstrual dysfunction and the second is to reliably exclude premalignant or malignant disease.

Recent advances in imaging techniques have allowed for noninvasive (without surgery) detection of polyps in the uterus and cervix. These include specialized diagnostic procedures called transvaginal ultrasound (TVUS) and saline infusion sonography (SIS). Ultrasound is frequently requested for the evaluation of pelvic pain, infertility, screening purposes, and in cases where a standard pelvic exam does not provide a full clinical assessment. The ultrasound is often particularly helpful in imaging/visualizing the endometrium. Ultrasonographers can reliably determine the endometrial thickness and texture. When the endometrial is thickened, then gynecologists can better ascertain the causes of thickening by performing simple procedures like SIS or office hysteroscopy. These quick office-based procedures can reliably determine the presence of endometrial polyps.

Patients who have symptomatic uterine polyps can be offered minimally invasive treatment with removal of polyps using a small tube inserted in the uterus (operative hysteroscopy). This technique permits rapid, safe, and effective removal of the polyp with minimal anesthesia as an outpatient procedure. Because the tube is inserted into the vagina for access to the uterus, conventional abdominal surgery can be avoided. Fortunately, polyps rarely reoccur when removed completely at hysteroscopy.

SEE ALSO: Dysmenorrhea, Menstrual cycle disorders

Suggested Reading

  • DeWaay, D. J., Syrop, C. H., Nygaard, I. E., et al. (2002). Natural history of uterine polyps and leiomyomata. Obstetrics and Gynecology, 100, 3—7.
  • Gebauer, G., Hafner, A., Siebzehnrubl, E., & Lane, N. (2001). Role of hysteroscopy in detection of endometrial polyps: Results of a prospective study. American Journal of Obstetrics and Gynecology, 184, 59-62.
  • Kamel, H. S., Darwish, A. M., & Mohamed, S. A. (2000). Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps. Acta Obstetricia et Gynecologica Scandinavica, 79, 60-64.

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