Uterine polyps
What is a uterine polyp?
A uterine polyp, or endometrial polyp, is an abnormal growth of tissue that occurs on the inner lining of the uterus, known as the endometrium. It may have a flat base or be attached to the uterus by a long stalk, and its size ranges from a few millimeters to several centimeters.
It is one of the most common gynecological findings—it is estimated to occur in up to 10% of women—and in the vast majority of cases, it is benign. It occurs most frequently in women approaching menopause, though it can also occur in younger women.
How uterine polyps form
The exact causes of uterine polyps have not been fully elucidated. However, it appears that their development is significantly influenced by hormone levels, and specifically, they grow in response to estrogen.
Risk factors associated with the development of uterine polyps include obesity, high blood pressure, a history of cervical polyps, as well as the use of certain medications such as tamoxifen or hormone replacement therapy.
Symptoms
Uterine polyps often cause no symptoms and are discovered incidentally during a gynecological ultrasound. When symptoms are present, the most common is abnormal bleeding in various forms.
The most common symptoms include irregular menstrual bleeding, bleeding between periods (spotting), excessively heavy menstrual bleeding, and vaginal bleeding after menopause.
In cases where the polyp protrudes from the cervix into the vagina, it may also cause pain during menstruation.
Important: The symptoms of uterine polyps are common to other gynecological conditions, a fact that often delays diagnosis. Any abnormal bleeding should be evaluated by a specialized gynecologist.
When is a uterine polyp dangerous?
In the vast majority of cases, uterine polyps are benign. However, there are certain cases that require special attention.
The risk of malignancy is higher in postmenopausal women, in those experiencing postmenopausal bleeding, in obese women, and in those taking tamoxifen for breast cancer treatment.
Furthermore, even benign polyps can cause problems when they grow near the fallopian tubes or when they act as a physical barrier to embryo implantation, thereby affecting fertility.
Diagnosis
Uterine polyps are diagnosed using two main tests:
Transvaginal Ultrasound
This is the first diagnostic step and allows for the detection of polyps in the uterus. However, detection via ultrasound can be difficult in some cases, especially when there is endometrial hyperplasia. For this reason, a negative ultrasound result does not always rule out the presence of polyps.
Hysteroscopy
This is the most reliable diagnostic method. A small camera is inserted through the cervix, allowing for direct visualization of the endometrium and the polyp. Hysteroscopy has the significant advantage of allowing both the diagnosis and removal of the polyp during the same procedure.
Treatment
The treatment of uterine polyps depends on their size, symptoms, and characteristics, as well as the woman’s age and reproductive plans.
In some cases of small, asymptomatic polyps, the gynecologist may recommend simple monitoring, as smaller polyps may resolve on their own.
However, this does not apply to all cases, and the decision is always made on an individual basis.
Hysteroscopic Removal
This is the method of choice for removing uterine polyps. In the case of a large polyp, it is cut into sections before being removed. The procedure is usually performed under general anesthesia, and the patient returns to her daily activities within a short period of time.
After removal, the polyp is sent for histological examination to rule out the presence of malignant cells. In rare cases where cancer cells are found, the gynecologist will discuss the next steps in treatment.
Uterine Polyps and Fertility
Uterine polyps can affect fertility through various mechanisms. Depending on their location and size, they can act as a physical barrier to embryo implantation, block the fallopian tube, rendering it non-functional, or obstruct the cervical opening. For this reason, the evaluation and treatment of uterine polyps is an important step in the investigation of infertility.
Natural Conception
Statistics show an increase in conception rates in women following polyp removal. However, it has not been sufficiently studied whether removal directly affects fertility, so each case is evaluated individually by the gynecologist.
In Vitro Fertilization
The presence of uterine polyps may increase the risk of miscarriage in women undergoing in vitro fertilization. For this reason, a gynecological examination and treatment of any polyps are usually a necessary step before starting an IVF protocol.
If you are planning a pregnancy and a uterine polyp has been detected, discuss treatment options with your gynecologist before proceeding with any attempts to conceive.
Frequently Asked Questions (FAQ)
In some cases, small polyps may resolve on their own; however, this is not true in all cases. A “wait-and-see” approach is not recommended, as a polyp that does not resolve may cause symptoms or affect fertility. The decision to monitor or remove a polyp is always made in consultation with your gynecologist.
Yes, polyps tend to recur even though their removal is usually successful. For this reason, regular follow-up with a gynecological ultrasound after the procedure is essential. In women with recurrent polyps, the gynecologist may recommend appropriate hormonal therapy to prevent their recurrence.
Yes, uterine polyps can cause menstrual cycle irregularities, including delayed or irregular periods. This is due to the polyp’s effect on the endometrium and hormone levels. If you notice changes in your cycle, discuss this with your gynecologist.
In most cases, uterine polyps do not cause pain. However, when a polyp is large or protrudes from the cervix into the vagina, it can cause pain during menstruation or sexual intercourse. The presence of pain combined with abnormal bleeding is a clear indication for a gynecological evaluation.
Yes, the appearance of uterine polyps after menopause requires immediate evaluation by a specialist gynecologist. The risk of malignancy is relatively higher in postmenopausal women, especially when accompanied by bleeding. In most cases, immediate removal and histological examination are recommended.
Get a second opinion! Schedule an appointment
