Uterine Polyps

Uterine polyps or endometrial polyps are endometrial tissue that overgrows. They are round or oval shapes with a thin stalk or broad base attached to the uterine lining. The size may be as tiny as a sesame seed or bigger than a golf ball. You can develop one or more polyps. Usually, uterine polyps are noncancerous and asymptomatic. However, it can cause menstrual and fertility problems.

Causes and Risk Factors

• A surge of hormones such as estrogen during each menstrual cycle causes endometrial thickening, which can be associated with the growth of uterine polyps. 
• Old age increases the risk of developing uterine polyps. You are more likely to have uterine polyps when you are perimenopausal or postmenopausal.
• Overweight or obesity
• Hypertension
• Tamoxifen for breast cancer treatment
• Hormone replacement therapy with high doses of estrogen.
• Lynch syndrome 
• Cowden syndrome

Symptoms

• Abnormal vaginal bleeding after intercourse, outside of the menstrual period, or after menopause
• Irregular periods
• Heavy menstrual bleeding
• Infertility 
• Dull abdominal aching due to large polyps
• Sometimes, a uterine polyp may resemble endometrial carcinoma or endometrial hyperplasia. 

Diagnosis

• History taking: Your doctor will ask about your menstrual cycle, menopausal status, and whether you have vaginal spotting. 
• Pelvic exam and a Pap smear
• Transvaginal ultrasound
• Saline infusion sonohysterography
• Hysteroscopy
• Endometrial biopsy
• Curettage

Treatment

• Surveillance: Treatment for asymptomatic polyps may not be necessary as they may go away on their own, especially if you are not at risk of developing uterine cancer.
• Medication: Taking medications such asprogestins and gonadotropin-releasing hormone agonists can help alleviate symptoms caused by the polyp. But symptoms can recur if you stop the drugs.   
• Surgical removal such as hysteroscopy: Your doctor will order a pathological study of the removed polyps to determine if they are cancerous. Around 5% of uterine polyps are cancerous. Uterine polyps can recur that need repeat treatment.

Article by
Dr Pimpagar Chavanaves

An obstetrician & gynecologist specializing in reproductive endocrinology and menopause
Doctor profile
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