Uterine polyps are growths that form in the lining of the uterus, known as the endometrium. Many people discover these growths while seeking answers for symptoms like irregular bleeding or difficulty conceiving. A common concern is whether these growths cause pain, or “hurt.” This article explains what uterine polyps are, addresses the question of pain, and details how doctors identify and manage them.
Understanding Uterine Polyps
Uterine polyps, also called endometrial polyps, are localized overgrowths of the tissue lining the inside of the uterus. They form when endometrial tissue grows excessively, creating a projection that attaches to the uterine wall either by a thin stalk or a broad base. These growths vary significantly in size, ranging from a few millimeters to several centimeters. They can occur singly or in clusters within the uterine cavity.
The development of polyps is influenced by hormonal factors, as the growths are sensitive to estrogen. This is the hormone that causes the endometrium to thicken each month during the menstrual cycle. Most uterine polyps are non-cancerous, or benign, but a small percentage may contain precancerous or cancerous cells. While they can occur at any age, they are most frequently observed in individuals in their 40s and 50s, particularly around perimenopause and menopause.
Common Symptoms and Addressing the Pain Question
The majority of uterine polyps do not cause noticeable symptoms and are discovered incidentally during unrelated medical examinations. When symptoms do occur, the most frequently reported issue is abnormal uterine bleeding. This can manifest as spotting or bleeding between menstrual periods, unusually heavy menstrual flow, or irregular periods. Bleeding after menopause is also a common symptom that warrants medical evaluation.
To directly address the question of whether uterine polyps “hurt,” the answer is generally no; sharp, severe pain is not a typical symptom. However, some individuals may experience mild discomfort or menstrual-like cramping. This discomfort is sometimes associated with a very large polyp, or if the polyp slips through the cervix and into the vagina, a condition known as prolapse. Polyps can also be a factor in infertility, interfering with the implantation of a fertilized egg or blocking the fallopian tubes.
Methods of Identification and Diagnosis
The process of identifying uterine polyps often begins with a review of the patient’s history and a routine pelvic examination. If abnormal bleeding is reported, a doctor typically uses imaging tools to visualize the inside of the uterus. The first-line imaging technique is the transvaginal ultrasound (TVS), where a wand-like device is placed in the vagina to generate images of the uterus.
If TVS results are unclear, a more specialized test called a saline infusion sonohysterography (SIS) may be performed. This procedure involves injecting sterile salt water into the uterine cavity through a small catheter while simultaneously performing an ultrasound. The fluid gently expands the uterus, providing a clear outline of the polyp against the uterine wall, which significantly improves diagnostic accuracy compared to TVS alone.
The gold standard for both confirming the presence of a polyp and often treating it is hysteroscopy. This minimally invasive procedure involves inserting a thin, lighted telescope called a hysteroscope through the vagina and cervix into the uterus. Hysteroscopy allows for direct visualization of the growth, enabling the doctor to assess the size and location of the polyp before removal.
Treatment and Management Options
The management of uterine polyps depends on whether they are causing symptoms, their size, and the individual’s risk factors for uterine cancer. For small, asymptomatic polyps, particularly in premenopausal individuals, a doctor may recommend watchful waiting, as some growths can resolve spontaneously. If the polyp is large, symptomatic, or found in a postmenopausal individual, active removal is generally recommended due to the increased risk of malignancy.
The primary treatment method is a surgical procedure called hysteroscopic polypectomy. This is typically an outpatient procedure where specialized instruments are passed through the hysteroscope to carefully remove the polyp under direct visualization. Removing the polyp in this guided manner ensures the entire growth and its base are excised. The removed tissue is then sent for pathological analysis to check for cancer cells.
In some cases, hormonal medications like progestins may be used to manage symptoms, but this is usually a short-term solution as symptoms often return once the medication is stopped. Polypectomy offers symptom relief and is helpful for individuals experiencing abnormal bleeding or infertility. Following removal, there is a possibility of recurrence, and hormonal therapy may be utilized after the procedure to lower the chance of new growths forming.