Uterine polyps, also known as endometrial polyps, are common growths found in the lining of the uterus. They are typically benign, but can sometimes cause health concerns. These growths originate from the endometrium, the tissue shed monthly during the menstrual cycle. This article explains the nature of these growths, the factors that contribute to their development, how they are identified, and the available management strategies.
What Are Uterine Polyps
A uterine polyp is an overgrowth of endometrial tissue that projects into the uterine cavity. These growths attach to the inner wall of the uterus either by a thin, stem-like stalk or by a broad base. They can vary significantly in size, ranging from a few millimeters up to several centimeters.
While many polyps are asymptomatic, their presence can disrupt normal uterine function. The most frequent sign leading to their discovery is abnormal uterine bleeding. This can manifest as irregular menstrual periods, bleeding between expected cycles, or an unusually heavy flow. Bleeding after menopause warrants immediate evaluation, as does the presence of polyps when a person is experiencing difficulty becoming pregnant.
The Underlying Reasons Polyps Develop
The formation of uterine polyps is linked to hormonal activity, specifically the long-term influence of estrogen on the uterine lining. Estrogen stimulates the endometrium to proliferate each month in preparation for potential pregnancy. Polyps form when this localized growth becomes disorganized and excessive.
Advancing age is a significant factor, with polyps most common during the perimenopausal and postmenopausal years. Fluctuating hormone levels during these phases create an environment conducive to endometrial overgrowth.
Obesity is a recognized risk factor because fat tissue converts other hormones into estrogen, increasing the body’s overall estrogen exposure. High blood pressure, or hypertension, has been independently associated with a higher likelihood of polyp formation. The use of certain medications can also play a role in endometrial changes.
A notable example is Tamoxifen, a selective estrogen receptor modulator used in the treatment of breast cancer. While it acts as an anti-estrogen in breast tissue, it has an estrogen-like effect on the endometrium, promoting growth and leading to larger polyps. Patients taking Tamoxifen often require closer monitoring. Genetic predispositions may also contribute to the development of polyps in some individuals.
Identifying and Diagnosing Uterine Polyps
Identifying uterine polyps typically begins when a patient reports abnormal bleeding or other concerning symptoms. An initial step involves a pelvic examination and a review of the patient’s medical history. The primary tool for initial visualization is the Transvaginal Ultrasound (TVS).
TVS uses sound waves to image the uterus and detect if the endometrial lining is unusually thickened. However, TVS alone may not reliably distinguish a polyp from other conditions or simply thickened tissue. For a more definitive diagnosis, Saline Infusion Sonography (SIS) is often performed.
SIS, also known as a sonohysterography, involves injecting sterile saline solution into the uterine cavity through a thin catheter. The fluid expands the cavity, allowing the ultrasound to clearly outline the polyp, which appears as a distinct mass. This method confirms the presence, size, and location of the growth.
The most accurate method for diagnosis and direct visualization is a Hysteroscopy. A thin, lighted tube with a camera is inserted through the cervix into the uterus. This procedure allows the doctor to visually confirm the polyp and is often performed just before or at the same time as removal. Ultimately, any tissue removed must be sent to a lab for histopathological examination to rule out atypical cells or malignancy.
Treatment Options and Management
The approach to managing uterine polyps depends on several factors, including whether they are causing symptoms, the patient’s menopausal status, and any risk factors for cancer. Small, asymptomatic polyps, especially in pre-menopausal women, may be managed with observation. Up to 25% of these small polyps may resolve spontaneously without intervention.
Surgical removal is typically recommended for polyps causing symptoms, such as abnormal bleeding, or those with high-risk features like large size or presence in postmenopausal women. The standard procedure is a Hysteroscopic Polypectomy. This minimally invasive procedure uses a hysteroscope to directly visualize and excise the polyp from the uterine wall.
The removal is often an outpatient procedure, offering a precise way to clear the uterine cavity. Following the polypectomy, the removed tissue is always examined by a pathologist to check for signs of pre-cancerous cells or malignancy. This is a rare but present risk, particularly in postmenopausal individuals. After treatment, managing underlying risk factors, such as maintaining a healthy weight or controlling hypertension, may help reduce the likelihood of recurrence.