INTRODUCTION
Uterine (endometrial) polyps consist of areas in your uterus where the
lining of the uterus (endometrium) becomes overgrown and forms a mass
(polyp). Uterine polyps may attach to the interior of your uterus by a large
base or a thin stalk and range in size from a few millimeters — the size
of a sesame seed — to several centimeters — the size of a golf ball or
larger.
As the polyps grow, they protrude into your uterus. You can have one or
many uterine polyps. The polyps may stay contained within your uterus, or
occasionally, they may slip down through the opening of the uterus (cervix)
into the vagina. A uterine polyp that develops near the fallopian tubes may
obstruct the opening of the tubes, possibly leading to difficulty in
becoming pregnant.
Although they can happen at any time, uterine polyps most commonly occur
in women in their 40s and 50s.
SIGNS AND SYMPTOMS
Many women with uterine polyps are asymptomatic — having no signs or
symptoms. However, other women with uterine polyps experience one or more of
the following:
Irregular menstrual bleeding, such as bleeding varying amounts at
frequent but unpredictable intervals
Bleeding between menstrual periods
Excessively heavy menstrual periods
Vaginal bleeding after menopause
Uterine polyps can develop in pre- or postmenopausal women.
Postmenopausal women may experience only light bleeding or spotting.
CAUSES
Although there's no definitive cause of uterine polyps, hormonal factors
appear to play a role. Uterine polyps are estrogen-sensitive, meaning that
they respond to estrogen in the same way that the lining of your uterus (endometrium)
does — growing in response to circulating estrogen.
RISK FACTORS
You're at greater risk of developing uterine polyps if:
You're obese
You take tamoxifen (Nolvadex), a drug therapy for breast cancer
You have high blood pressure (hypertension)
You have cervical polyps
WHEN TO SEEK MEDICAL ADVICE
If you experience any signs or symptoms of uterine polyps, such as
irregular bleeding or bleeding between periods, seek prompt medical
attention.
SCREENING AND DIAGNOSIS
If your doctor suspects that you have uterine polyps, he or she might
perform one of the following tests or procedures:
Transvaginal ultrasound. Your
doctor places in your vagina a slender, wand-like device that sends out
sound waves and creates an image of your uterus. This imaging test
allows your doctor to identify abnormalities in your uterus. In a
closely related procedure, known as sonohysterography, your doctor
injects salt water (saline) into your uterus through a small tube
(catheter) threaded into your uterus by way of your vagina. The saline
fills and expands your uterine cavity, which allows the doctor to better
visualize the inside of your uterus during the ultrasound.
Hysteroscopy. Many doctors
perform a procedure called hysteroscopy to diagnose and treat uterine
polyps. In a hysteroscopy, your doctor inserts a thin, flexible, lighted
telescope (hysteroscope) through your vagina into your uterus.
Hysteroscopy not only allows your doctor to view the inside of your
uterus to examine it for the presence of polyps, but also makes it
possible to remove the polyps at the same time. This eliminates the need
for a follow-up procedure.
Curettage. Your doctor uses a
long metal instrument with a loop on the end (curet) to scrape the walls
of your uterus. This may be done to collect a specimen for laboratory
testing (biopsy) or to remove the polyps. Curettage may be performed on
it own (blind curettage) or with the guidance of a hysteroscope. Blind
curettage makes finding uterine polyps more difficult than if your
doctor is able to visualize the inside of your uterus.
Most uterine polyps are non-cancerous (benign). However, some
pre-cancerous
changes of the uterus (endometrial hyperplasia) or uterine cancers
(endometrial carcinoma) appear as uterine polyps. Your doctor may send a
tissue sample for laboratory analysis to be certain you don't have uterine
cancer.
COMPLICATIONS
Uterine polyps may present an increased risk of miscarriage in women
undergoing in vitro fertilization (IVF) treatment for infertility. If you're
undergoing IVF treatment and you have uterine polyps, your doctor may
recommend polyp removal before embryo transfer.
TREATMENT
Possible treatments for uterine polyps include:
Surgical removal (excision). If
you undergo hysteroscopy, special instruments inserted through the
hysteroscope — the device your doctor uses to see inside your uterus
— make it possible to cut away and remove any polyps once they're
identified. The removed polyp may be sent to a laboratory for
microscopic examination.
Hysterectomy. If closer
examination reveals that your uterine polyps contain cancerous cells,
surgery to remove your uterus (hysterectomy) becomes necessary.
Uterine polyps, once removed, can recur. It's possible that you might
need to undergo treatment more than once if you experience recurring uterine
polyps.
2007 Women's Associates, P.C.
