Endometrial polyps are common growths that develop in the lining of the uterus, known as the endometrium. These growths are typically benign, meaning they are not cancerous, and can vary in size from a few millimeters to several centimeters. Understanding their identification and removal is important for those experiencing symptoms or concerns.
Understanding Endometrial Polyps and Removal Rationale
Endometrial polyps form due to an overgrowth of the tissue that lines the inside of the uterus. They can be attached to the uterine wall by a broad base or a thin stalk. The most common symptom is abnormal uterine bleeding, which can manifest as heavy menstrual periods, bleeding between periods, or vaginal bleeding after menopause. Polyps may also contribute to difficulty conceiving or recurrent miscarriages by interfering with embryo implantation.
Removal of endometrial polyps is often considered to alleviate these disruptive symptoms and improve fertility outcomes. Although most polyps are benign, a small percentage may contain precancerous or cancerous cells, particularly in postmenopausal individuals. Therefore, removal also allows for a tissue sample to be analyzed. When symptoms are present or there is a concern for potential malignancy or fertility impact, removal is generally a recommended course of action.
Diagnosing Endometrial Polyps
Identifying endometrial polyps typically begins with imaging techniques. Transvaginal ultrasound (TVS) is often the initial non-invasive method used, where a small device is inserted into the vagina to produce images of the uterus. While TVS can indicate thickened endometrial tissue or focal masses, it may not always definitively distinguish polyps from other conditions.
To enhance diagnostic accuracy, saline infusion sonography (SIS), also known as sonohysterography, may be performed. This procedure involves injecting sterile saline solution into the uterus through a thin catheter, which expands the uterine cavity and provides a clearer view during a transvaginal ultrasound. SIS is considered more sensitive and accurate than TVS alone for detecting endometrial polyps, as the fluid helps outline the polyp. In some cases, a diagnostic hysteroscopy might be used, where a thin, lighted telescope is inserted directly into the uterus to visually inspect the lining and confirm the presence of polyps.
Surgical Removal Procedures
The primary and most effective method for removing endometrial polyps is hysteroscopic polypectomy. This minimally invasive surgical procedure involves inserting a hysteroscope, a thin, lighted telescope with a camera, through the vagina and cervix into the uterus. Fluid, typically saline, is introduced to gently expand the uterine cavity, providing the surgeon with a clear, magnified view of the polyps on a monitor. This direct visualization allows for precise identification and removal.
Specialized instruments are then passed through channels within the hysteroscope to remove the polyps. These instruments can include grasping forceps, scissors, or a resectoscope with a wire loop that can cut or shave off the polyp. The removed tissue is then collected and sent to a laboratory for examination to confirm the diagnosis and rule out cellular changes. The procedure is typically performed on an outpatient basis, meaning patients usually go home the same day. Anesthesia options vary, ranging from local or regional anesthesia to general anesthesia, depending on the complexity of the case and patient preference.
While hysteroscopic polypectomy is the preferred approach, dilation and curettage (D&C) is an older method that might be used, though it is less precise for targeted polyp removal. D&C involves dilating the cervix and then using a curette, a spoon-shaped instrument, to scrape the uterine lining. This method is often performed blindly, making it less effective at ensuring complete removal of all polyps compared to hysteroscopy, which allows for direct visualization.
Post-Procedure Care and Monitoring
After hysteroscopic polypectomy, mild cramping, similar to menstrual cramps, and light vaginal bleeding or spotting are typical for a few days up to a couple of weeks. Over-the-counter pain relievers can usually manage any discomfort. It is generally advised to avoid inserting anything into the vagina, such as tampons, and to refrain from sexual intercourse for about one to two weeks to reduce the risk of infection.
Most individuals can resume light activities within a day or two, with a gradual return to normal routines over a week. Follow-up appointments are important to ensure proper healing and to discuss the results of the polyp biopsy. While hysteroscopic removal is effective, it is possible for endometrial polyps to recur. Recurrence rates can vary. Regular gynecological check-ups can help monitor for any new developments.