Endometrial polyps are growths that develop in the endometrium, the tissue lining the inside of the uterus. These growths form when there is a localized overgrowth of the endometrial tissue, leading to finger-like or bulbous projections into the uterine cavity. They vary significantly in size, ranging from a few millimeters to several centimeters, and may be attached by a thin stalk or a broad base. While most endometrial polyps are benign, a small percentage may contain precancerous or cancerous cells, making accurate diagnosis important. The diagnostic process involves a methodical approach, starting with symptoms and moving through specialized imaging and tissue confirmation procedures.
Recognizing Symptoms and Initial Consultation
The first step in identifying a potential endometrial polyp is often the patient noticing a change in their bleeding pattern. The most frequently reported symptom is abnormal uterine bleeding, which can manifest in several ways. This includes bleeding between menstrual periods, unusually heavy or prolonged menstrual flow, or any vaginal bleeding occurring after menopause.
A physician begins the consultation by taking a detailed medical history to understand the specific pattern and timing of the symptoms. This history helps narrow down possible causes of the abnormal bleeding, such as hormonal imbalances or fibroids. A basic pelvic examination is also performed to check the cervix and vagina and rule out more obvious sources of bleeding. This initial assessment guides the decision to proceed with imaging studies to visualize the internal structure of the uterus.
Transvaginal Ultrasound: The Initial Screening
The evaluation typically begins with a transvaginal ultrasound (TVUS) because it is a non-invasive, readily available imaging technique. This procedure uses a slender, wand-like transducer inserted into the vagina, which emits sound waves to create an image of the uterus and its lining. Doctors primarily look for the thickness of the endometrial lining, often referred to as the endometrial stripe.
An excessively thickened or irregular endometrial stripe on TVUS suggests the presence of a polyp, but this method has limitations in providing a definitive diagnosis. Standard ultrasound often struggles to distinguish a focal polyp from a generalized thickening of the entire endometrium. TVUS may miss smaller polyps or those obscured by other masses like submucosal fibroids. Therefore, TVUS serves as an effective screening tool that highlights the need for further investigation rather than confirming the growth itself.
Specialized Imaging: Saline Infusion Sonography
When TVUS suggests an endometrial abnormality but cannot definitively characterize it, the next step is often Saline Infusion Sonography (SIS), also known as hysterosonography. This specialized procedure significantly improves diagnostic clarity by introducing a sterile saline solution directly into the uterine cavity through a thin catheter placed via the cervix. The saline acts as an acoustic contrast agent, gently distending the uterine walls.
By filling the cavity with fluid, a mass such as a polyp becomes clearly outlined within the fluid-filled space. This technique allows the physician to visualize the polyp’s specific size, shape, and point of attachment, separating it distinctly from the surrounding endometrial tissue. The enhanced contrast provided by SIS is significantly more accurate than standard TVUS for detecting and characterizing endometrial polyps.
Hysteroscopy and Definitive Tissue Confirmation
The final and most definitive step in the diagnostic pathway is often hysteroscopy, which is considered the gold standard for both diagnosis and treatment. This procedure involves inserting a thin, flexible, lighted telescope, called a hysteroscope, through the vagina and cervix directly into the uterine cavity. The hysteroscope provides the physician with a magnified, direct visual inspection of the uterine lining.
Hysteroscopy allows for the precise identification of a polyp’s location, size, and appearance. The procedure is often therapeutic, as small surgical instruments can be passed through the hysteroscope to remove the polyp completely, a procedure known as polypectomy. The removed tissue is then sent to a pathology lab for histological examination. This analysis is the only way to confirm the benign nature of the growth and rule out the possibility of precancerous or cancerous changes.