Benign endometrial polyps are noncancerous growths that develop from the inner lining of the uterus, known as the endometrium. These growths protrude into the uterine cavity and can vary in size, from a few millimeters, like a sesame seed, to several centimeters, resembling a golf ball or larger. The term “benign” means these polyps are noncancerous and do not typically spread. Endometrial polyps can be attached to the uterine wall by a thin stalk or a broad base, and a person may have one or multiple polyps.
Causes and Risk Factors
The precise cause of endometrial polyps is not fully understood, but hormonal influences play a significant role in their development. Endometrial cells are sensitive to estrogen; an overgrowth in response to estrogen levels can lead to polyp formation, often observed during hormonal fluctuations.
Several factors increase the likelihood of developing these polyps. Age is a risk factor, with polyps more common in women approaching or past menopause. Other established risk factors include obesity, high blood pressure (hypertension), and the use of certain medications. For instance, tamoxifen, a medication used in breast cancer treatment, has been linked to a higher risk of endometrial polyps due to its estrogen-like effects on uterine tissue.
Associated Symptoms
Abnormal uterine bleeding is the most frequently reported symptom associated with endometrial polyps. This can manifest as heavy menstrual periods (menorrhagia), where blood flow is unusually abundant. Bleeding between periods, or intermenstrual bleeding, is another common sign, often appearing as spotting or irregular vaginal discharge. Postmenopausal bleeding, which is any vaginal bleeding occurring after menopause, also frequently indicates the presence of polyps.
Polyps can also contribute to difficulties with conception and infertility. This may occur because the polyps can physically interfere with embryo implantation within the uterine cavity. Despite these potential symptoms, many endometrial polyps remain asymptomatic, meaning they produce no noticeable signs or discomfort. These silent polyps are often discovered incidentally during medical examinations or procedures performed for other reasons.
Diagnosis Process
Confirming an endometrial polyp begins with assessing a patient’s symptoms and medical history. Doctors often employ several diagnostic tools to visualize the uterine cavity and identify any growths. The most common initial test is a transvaginal ultrasound, where a slender, wand-like device is inserted into the vagina to create images of the uterus using sound waves. This can reveal thickened endometrial tissue or suggest the presence of a polyp.
To obtain a clearer view, a sonohysterography, also known as a saline-infusion sonogram, may be performed. This procedure involves injecting sterile salt water into the uterus through a thin tube, which expands the uterine cavity and allows for enhanced visualization of any polyps during the ultrasound. For a more definitive diagnosis, a hysteroscopy is often used. This involves inserting a thin, flexible tube with a lighted camera, called a hysteroscope, through the vagina and cervix directly into the uterus, enabling the doctor to visually inspect the endometrial lining and any polyps. During hysteroscopy, a tissue sample (biopsy) is often taken from the polyp to confirm it is benign and rule out cancerous changes.
Treatment and Management
The approach to managing benign endometrial polyps varies depending on their size, the presence and severity of symptoms, and individual patient factors. For small polyps that are not causing any symptoms, a strategy of “watchful waiting” may be recommended. Some small polyps, particularly in premenopausal women, may resolve on their own without intervention. Regular monitoring through follow-up ultrasounds can help track any changes in these polyps.
Hormonal medications, such as progestins, can sometimes manage symptoms like abnormal bleeding. However, these medications are a short-term solution, as symptoms often return once treatment stops, and they do not eliminate the polyps. The most common and definitive treatment for symptomatic polyps, or those raising concern, is surgical removal.
The standard surgical procedure is hysteroscopic polypectomy, performed using a hysteroscope to directly visualize and remove the polyp from the uterine lining. This minimally invasive procedure is often done on an outpatient basis. Surgical removal is particularly recommended for women experiencing abnormal bleeding, those facing infertility issues attributed to polyps, or individuals with risk factors for uterine cancer, such as postmenopausal women. The removed tissue is then sent for pathological examination to confirm its benign nature.