Benign growths can develop within the uterus, potentially causing symptoms that affect daily life. Understanding these common conditions is important for managing potential concerns.
Understanding Uterine Fibroids
Uterine fibroids, also known as leiomyomas, are non-cancerous growths from the muscular wall of the uterus. They are common, affecting 40% to 80% of individuals with a uterus, often between 30 and 50 years old. Fibroids vary significantly in size, from tiny to large masses that can alter uterine shape.
They are classified based on their location within or on the uterus. Intramural fibroids grow within the muscular wall, subserosal fibroids develop on the outer surface, and submucosal fibroids protrude into the uterine cavity. Pedunculated fibroids are a type of subserosal fibroid that grows on a stalk.
Many fibroids cause no symptoms. When they do, common symptoms include heavy menstrual bleeding, prolonged periods, pelvic pressure or pain, frequent urination, lower back pain, constipation, or discomfort during sexual activity. Fibroids may also contribute to fertility issues. Their exact cause is not fully understood, but growth is linked to estrogen and progesterone, with family history, ethnicity, and obesity as associated factors.
Understanding Endometrial Polyps
Endometrial polyps are overgrowths of the uterine lining (endometrium). They are typically benign, though a small percentage (around 3.1%) can contain precancerous or cancerous cells. Polyps can appear as finger-like or round/oval shapes, attaching to the uterine lining by a thin stalk or a broad base.
Their size varies from a few millimeters to several centimeters. Many individuals with polyps experience no symptoms, but abnormal uterine bleeding is the most common indicator. This includes irregular menstrual periods, bleeding or spotting between periods, unusually heavy flow, or bleeding after menopause.
Bleeding after sexual intercourse is another symptom. Like fibroids, polyps can contribute to fertility challenges. Their formation is influenced by hormonal fluctuations, particularly estrogen levels. They are more frequent in individuals in their 40s and 50s, with risk factors including obesity and Tamoxifen use.
The Possibility of Co-Existence
Uterine fibroids and endometrial polyps can co-exist. Research indicates that these two conditions, though distinct in tissue origin, can occur together. A study found 20.1% of women with fibroids also had endometrial polyps.
Their co-occurrence is often related to shared hormonal sensitivities, as both are influenced by estrogen and progesterone. Fibroids originate from the muscular wall (myometrium), while polyps arise from an overgrowth of the endometrial lining.
This difference in tissue origin means they are separate entities, even with similar triggers. Fibroids can grow very large, sometimes stretching the uterus, while polyps typically remain smaller. Polyps also carry a small risk of precancerous or cancerous changes, which is not a concern with fibroids. Despite these differences, both conditions can present with overlapping symptoms like heavy menstrual bleeding, irregular periods, and infertility.
Pathways to Diagnosis and Treatment
Diagnosis often begins with imaging. Transvaginal ultrasound is a common initial method to visualize both types of growths. For detailed views, especially of polyps or submucosal fibroids, saline infusion sonography (SIS) can be performed.
Hysteroscopy, where a scope is inserted into the uterus, allows direct visualization and immediate removal. For polyps, a biopsy is often necessary to rule out cancerous cells. Larger fibroids may be detected by pelvic examination, and MRI can provide comprehensive imaging.
Treatment is tailored to the individual, considering symptoms, growth size and location, and fertility desires. For small or asymptomatic growths, watchful waiting may be recommended. Medications, such as hormonal therapies, can help manage symptoms like heavy bleeding associated with both conditions.
For polyps, hysteroscopic polypectomy is the standard treatment. Fibroid treatment options are varied, including myomectomy (surgical removal while preserving the uterus) or uterine artery embolization (UAE), which blocks blood flow to shrink them. Hysterectomy, the surgical removal of the uterus, may be considered if other treatments are ineffective or fertility preservation is not a concern. Fibroids can sometimes recur after treatment.