Uterine polyps are soft, fleshy tissue growths that develop in the female reproductive organs and are typically benign. They are an overgrowth of cells originating from the lining of the uterus or the cervix. While many polyps remain asymptomatic, they can sometimes lead to noticeable discomfort or pain.
Defining Uterine Polyps and Their Types
Polyps are small lumps or nodules that grow away from the surface of the organ, often attached by a thin stalk or a broad base. They range in size from a few millimeters to several centimeters. Their formation is linked to the overgrowth of cells in response to hormonal changes, particularly the presence of estrogen.
There are two primary types distinguished by their location. Endometrial polyps arise from the endometrium, the inner lining of the uterus, and project into the uterine cavity. Cervical polyps grow from the epithelial cells of the cervix, the narrow canal that connects the uterus to the vagina. Although polyps are noncancerous, a small percentage can be precancerous or cancerous.
The Relationship Between Polyps and Uterine Pain
The majority of uterine polyps do not cause pain, and many women are unaware of their presence. When pain occurs, it is often described as cramping or a dull abdominal aching, similar to menstrual cramps. This discomfort is typically mechanical, arising from the uterus attempting to expel the foreign body.
Larger polyps are more likely to cause cramping due to their size and the pressure they exert on the uterine wall. Another mechanism involves a pedunculated polyp, attached by a long, thin stalk. If this polyp twists (torsion), it can cut off its blood supply, leading to acute discomfort. Furthermore, a large polyp can sometimes prolapse, slipping through the cervical opening into the vagina, which causes significant pelvic pain or pressure.
While pain is a possible symptom, the most common symptom is abnormal uterine bleeding. This bleeding can manifest as spotting between menstrual periods, unusually heavy menstrual flow, or bleeding after menopause.
Confirmation and Removal Procedures
Identifying uterine polyps often begins with imaging tests, especially if a patient is experiencing symptoms like abnormal bleeding. A transvaginal ultrasound is typically the first step, using a device placed into the vagina to create images of the uterus. This technique reveals thickened tissue or growths within the uterine lining.
A more detailed diagnostic method is saline infusion sonography, also called hysterosonography. This procedure involves injecting a sterile salt water solution into the uterus through a thin catheter, which gently expands the uterine cavity. The saline provides a clearer contrast for the ultrasound, allowing the physician to better visualize the polyps.
The definitive method for both diagnosis and treatment is hysteroscopy. During this procedure, a thin, lighted telescope called a hysteroscope is inserted through the vagina and cervix directly into the uterus. This allows the physician to visually inspect the uterine lining and confirm the presence of polyps.
Polypectomy, the surgical removal of the polyp, is the standard treatment for symptomatic growths. Hysteroscopy is often used to perform the polypectomy, as the surgeon uses specialized instruments to grasp and remove the polyp. This procedure is typically minimally invasive and often performed on an outpatient basis. After removal, the tissue is sent to a pathology lab for histological examination to confirm its nature and rule out precancerous or cancerous cells.