Endometrial polyps are growths that form on the inner lining of the uterus, known as the endometrium. They are a common gynecological finding, often appearing as soft, finger-like projections.
What Are Endometrial Polyps?
Endometrial polyps are typically non-cancerous growths that originate from an overgrowth of cells in the uterine lining. They can vary considerably in size, ranging from a few millimeters to several centimeters (the size of a golf ball or larger). These polyps can be singular or multiple, and they attach to the uterine wall either by a broad base or a thin stalk. While most common in women approaching or past menopause, they can occur in individuals of any age.
Do Endometrial Polyps Resolve Naturally?
Some smaller endometrial polyps, particularly in premenopausal women, may resolve on their own without medical intervention. Studies indicate that some smaller polyps, especially those under 10 mm, may disappear over a one-year period, with regression rates up to 25% observed in premenopausal women. Factors influencing this natural resolution include the polyp’s size and hormonal fluctuations. Spontaneous resolution is not guaranteed for all polyps, and larger polyps are less likely to disappear. Medical evaluation remains important to assess the characteristics of any identified polyp.
Identifying Endometrial Polyps
Endometrial polyps frequently cause no noticeable symptoms, especially if they are small or solitary. When symptoms do occur, the most common is abnormal uterine bleeding. This can manifest as irregular menstrual periods, bleeding or spotting between periods, unusually heavy menstrual flow, or vaginal bleeding after menopause. Large polyps might also cause mild abdominal discomfort.
Healthcare providers use several methods to identify these growths:
Transvaginal ultrasound: A slender device inserted into the vagina creates images of the uterus, showing thickened endometrial tissue or visible polyps.
Saline infusion sonography (SIS) or sonohysterography: Sterile saline is injected into the uterus to expand the cavity, providing clearer ultrasound images.
Hysteroscopy: A thin, lighted telescope inserted into the uterus allows for direct visualization of the polyps.
Biopsy: A tissue sample is often taken during hysteroscopy or through a suction catheter for laboratory analysis to confirm the diagnosis.
Approaches to Management
The management of endometrial polyps depends on various factors, including symptom presence, polyp size, and individual risk factors for malignancy or fertility concerns. For small, asymptomatic polyps, especially in premenopausal women, a “watchful waiting” approach may be recommended, as some may resolve spontaneously. Regular follow-up appointments are advised in such cases.
When polyps cause symptoms, are large, or have concerning features, surgical removal is recommended. Hysteroscopic polypectomy is the standard surgical treatment, involving the insertion of a hysteroscope to visually guide polyp removal. This procedure allows for precise removal and can often be performed in an outpatient setting. Medications, such as hormonal therapies, might temporarily shrink polyps and alleviate symptoms, but symptoms often return once medication stops. The removed tissue is sent for pathological examination to confirm its benign nature or identify any concerning changes.
Potential Health Implications
Although most endometrial polyps are benign, there is a small risk that they could contain precancerous or, rarely, cancerous cells. This risk is generally low, estimated between 0.5% and 1% for cancerous transformation, but it increases with age, especially in postmenopausal women, and in those with certain risk factors like obesity or tamoxifen use.
Beyond the potential for malignancy, endometrial polyps can also impact fertility. They may interfere with the ability to conceive by affecting embryo implantation or by creating a local inflammatory response within the uterus. Studies have shown that removing polyps can significantly improve pregnancy rates in individuals experiencing infertility.