|What Are Uterine Polyps?
Terminology: Uterine polyps are also called endometrial polyps and intrauterine polyps.
Uterine polyps are growths of excess tissue that form on the inner wall of the uterus (womb) - and remain attached by a thin stalk. A woman can have a single or multiple polyps and they range in size from a few millimeters to several centimeters (up to the size of a golf ball). Usually they stay within the uterus but occasionally they grow long enough to slip down into the vagina. Fortunately they are rarely cancerous. In study of 509 women who were treated for the condition, less than 1 percent showed signs of cancer - although 26 percent had endometrial hyperplasia, sometimes considered a pre-cancer stage. Read more about the signs of endometrial cancer in women.
What Are The Symptoms?
Sometimes uterine polyps are asymptomatic - meaning they do not cause symptoms. Many women in fact remain harmlessly undiagnosed. The symptoms of uterine polyps, if they do occur, usually include abnormal vaginal bleeding in both pre- and postmenopausal women. In fact polyps are responsible for nearly one quarter of cases of abnormal genital bleeding.
Other symptoms include:
• Oligomenorrhea, or irregular periods - occurs in 50 percent of cases.
• Menorrhagia - heavy periods, although this is less common.
• Spotting between periods.
• Vaginal bleeding after menopause.
• Dysmenorrhea: Intermittent severe cramping pain.
• Infertility, although this is still debatable.
What Causes It?
Doctors still do not fully understand the causes of uterine polyps. Suggested theories include:
• Abnormal response to the female hormone estrogen. Estrogen may over stimulate the growth of endometrial tissue.
• Chronic inflammatory disease that irritates the lining of the womb.
Who Gets It?
Uterine polyps are rare in women younger than 20 years of age. The incidence rises steadily with age and peaks between 50 and 60. It gradually declines after menopause. Endometrial polyps are present in between 10 to 24 percent of women undergoing endometrial biopsy or hysterectomy. Your risk of developing polyps is greater if you:
• Are obese.
• Take the breast cancer drug tamoxifen.
• Suffer from hypertension (high blood pressure).
• Have cervical polyps. 27 percent of all women with cervical polyps have endometrial polyps. This rises to 57 percent of postmenopausal women with cervical polyps.
Can Uterine Polyps Cause Infertility?
Whether uterine polyps and infertility are linked, is still debatable. Even those who accept there is a link are unsure as to how polyps can interfere with fertility. One theory is that the lesions agitate the lining of the womb making it more difficult for an embryo to implant. Or it could prompt a miscarriage after the embryo has implanted. One study showed that 63 percent of women who had uterine polyps removed got pregnant via intrauterine insemination (IUI); this compared to only 28 percent who did not have them removed but had IUI. For this reason, IVF fertility clinics usually recommend patients to have their polyps removed before starting IVF treatment and the implantation of embryos.
How Are They Diagnosed?
Uterine polyps are more difficult to diagnose than cervical polyps because they are not visible on visual inspection (unless they protrude into the vagina). For this reason, the diagnosis process is more extensive.
Initial consultation: Your doctor will ask you about your menstrual history, when you last had a period and how long it lasted for. Be sure to mention any unusual symptoms you may be experiencing such as excessive bleeding or spotting between cycles. He may also ask if you have any difficulties in getting pregnant. He will perform a pelvic examination to rule out other causes, the symtoms of cervical polyps for example are very similar. Once this is completed one of several tests will be ordered:
Transvaginal ultrasound: A transvaginal scan uses ultrasound technology. A slim handheld device called an ultrasound transducer is inserted in the vagina. The transducer emits sound waves which provide images of the inside of the uterus which the technician can view on a monitor.
Sonohysterography: This is a newer technique which is combined with a transvaginal ultrasound. A sterile fluid is squirted into the uterus through a thin tube called a catheter. The fluid causes the uterus to expand so that any growths can be spotted and examined more easily. They may discover that it is not polyps but rather uterine fibroids or endometriosis (another type of growth).
Hysteroscopy: Hysteroscopy procedure can be used to both diagnose and treat polyps (in combination with another treatment method). The doctor inserts a long thin tube with a lighted telescope (hysteroscope) through the vagina, up into the cervix and womb. This allows for an accurate visual inspection of the uterus.
Endometrial biopsy: This can be carried out in the gynecologist's office. The doctor uses a soft plastic instrument to collect a small tissue from the wall of the womb. The sample is sent to the laboratory for biopsy to check for abnormalities.
Dilation and Curettage (D&C): A D&C procedure is performed under general anesthetic in an operating theatre. It can both diagnose and treat polyps. The doctor collects a sample of tissue from the inside of the womb using a long metal instrument called a curette. The tissue will be sent to a lab for biopsy.
Note: Neither hysteroscopy or ultrasonography can reliably distinguish between malignant and benign polyps. A sample of the polyp tissue needs to be biopsied to make an accurate diagnosis (after biopsy or curettage).
How Are They Treated?
The treatment of uterine polyps may not be necessary if they asymptomatic. Some studies even indicate that polyps under 1cm can even spontaneously regress without any treatment - the larger the polyp however, the less likely it is to regress.
Polpys should be treated if they cause heavy bleedings or spotting, if there is a suspicion of precancerous changes or the woman wishes to become pregnant. The treatment options include:
Hormone Medications: Drugs to regulate hormone imbalances such as gonadotropin-releasing hormone agonists and progestins may be prescribed to relieve symptoms. This is usually only a temporary solution because as soon as you stop taking the medication, the symptoms return.
D&C: This is the most common procedure and is effective for smaller tumors. The growths are scraped from the wall of the uterus. It is always performed under general anesthesia. A D&C is also sometimes used in the treatment of cervical polyps (where polyps are particularly large and symtomatic).
Polypectomy: A polypectomy using a hysteroscope for guidance. A special grasping device is inserted through the hysteroscope and used to snag the polyp and remove it. Or instead of a grasping device, polypectomy can be done using an electrical loop to cut the growth out with a low dose of electricity.
Hysterectomy: If polyps continue to grow back, or there are signs of cancer, a hysterectomy (the removal of the womb) may be recommended.
There is a high probability of recurrence of polyps (up to 50 percent of cases) even with the above treatments (with the exception of hysterectomy).
Can Uterine Polyps Be Prevented?
You can reduce your risk factor by maintaining a healthy body weight and blood pressure level. Other than that, there are no known prevention methods.