Endometrial polyps are common growths that develop on the inner lining of the uterus, known as the endometrium. These overgrowths can affect individuals across various age groups, though they are particularly common in those nearing or beyond menopause. Understanding their presence and potential effects, including pain, is important for reproductive health. This article explores the nature of endometrial polyps, their associated symptoms, and diagnosis and management.
Understanding Endometrial Polyps
Endometrial polyps are overgrowths that project into the uterine cavity. They consist of dense, fibrous tissue, blood vessels, and glandular cells. Polyps vary in size, from a few millimeters like a sesame seed, to several centimeters, potentially as large as a golf ball. They can be solitary or multiple, attaching to the uterine wall either by a thin stalk (pedunculated) or a broad base (sessile).
Hormonal factors, particularly estrogen levels, play a significant role in their formation, though the exact cause is not fully understood. Estrogen causes the uterine lining to thicken each month, and polyps grow in response to this hormonal influence. Risk factors for developing endometrial polyps include obesity and tamoxifen use. While most polyps are benign, a small percentage, especially in postmenopausal individuals or those with abnormal bleeding, may be precancerous or cancerous.
The Nature of Pain and Other Symptoms
Many endometrial polyps are asymptomatic and discovered incidentally during routine examinations. However, when symptoms do occur, they are primarily related to abnormal uterine bleeding. This can manifest as irregular menstrual periods (unpredictable timing, length, or flow). Individuals might also experience bleeding or spotting between periods, or unusually heavy and prolonged menstrual flow. For those who have gone through menopause, any vaginal bleeding is a common symptom of endometrial polyps.
While pain is not the most common symptom, endometrial polyps can cause discomfort. Larger polyps or those that protrude through the cervix may lead to a dull ache or cramping in the abdomen or lower back, similar to menstrual cramps. Pain during sexual intercourse or general pelvic pain can also occur, especially if a polyp becomes infected. Irritation of surrounding uterine tissues by polyps can also contribute to pain or abnormal bleeding. Additionally, polyps can sometimes interfere with fertility by preventing a fertilized egg from implanting.
Diagnosis and Management
Diagnosis often begins with a medical history review and pelvic examination. If abnormal bleeding is present, further imaging studies are typically recommended. Transvaginal ultrasound is a common initial diagnostic tool, involving a small device inserted into the vagina to image the uterus and its lining. This can reveal thickened endometrial tissue or focal masses suggesting polyps. To enhance visualization, a saline infusion sonography (SIS) may be performed, involving sterile fluid injection into the uterus to expand the cavity for a clearer ultrasound view.
Hysteroscopy is the most accurate method for diagnosing and removing endometrial polyps. During this minimally invasive procedure, a thin, lighted hysteroscope is inserted through the vagina and cervix into the uterus, allowing direct visualization of the uterine lining. If polyps are identified, they can often be removed immediately using specialized instruments inserted through the hysteroscope, a procedure known as polypectomy. An endometrial biopsy, collecting a small tissue sample from the uterine lining, may also analyze for abnormal cells, though it might miss polyps if the sample is random.
Management depends on factors like symptoms, polyp size, and uterine cancer risk. Small, asymptomatic polyps, especially in premenopausal individuals, may resolve on their own, allowing for “watchful waiting”. For symptomatic polyps, or those that are large, multiple, or in postmenopausal individuals, surgical removal via hysteroscopic polypectomy is generally recommended. This procedure alleviates symptoms and allows for pathological evaluation of removed tissue to rule out precancerous or cancerous changes. While hormonal medications can temporarily alleviate symptoms, they typically do not eliminate the polyps.