Endometrial polyps are localized overgrowths of the tissue lining the inside of the uterus (endometrium). These growths are typically benign but range in size from a few millimeters to several centimeters. Removal is often recommended to manage symptoms, primarily abnormal uterine bleeding, such as heavy periods, spotting between cycles, or post-menopausal bleeding. The procedure is also performed to address infertility or to allow for pathological examination of the tissue. This examination rules out malignancy, which occurs in less than 5% of cases.
Preparing for Polyp Removal
Preparation begins with diagnostic imaging to confirm the polyp’s presence and location. A transvaginal ultrasound is the initial step, often followed by saline infusion sonography. This uses sterile saline to gently expand the uterine cavity for a clearer view, helping distinguish the polyp from other growths.
The procedure is typically scheduled immediately following the end of a menstrual period (one to ten days after). This timing ensures the endometrium is thinnest, providing the surgeon with the best visualization of the uterine cavity and the polyp’s attachment point. A pre-operative assessment includes a general health check and a review of medications, as patients may be asked to temporarily stop taking blood-thinning agents.
Anesthesia options, which depend on the number and size of the polyps, include local sedation or general anesthesia. If general anesthesia is planned, patients must fast for about six hours prior to surgery. Patients must also arrange transportation home, as driving is not permitted after receiving sedation.
The Hysteroscopic Procedure
Endometrial polyps are removed using hysteroscopic polypectomy, the standard minimally invasive surgical approach. This method avoids external incisions by accessing the uterus through the vagina and cervix. A hysteroscope, a long, thin instrument equipped with a camera and light source, is gently inserted into the uterine cavity.
To allow for clear visualization, a sterile fluid, often saline solution, is continuously infused to gently distend the cavity. The camera projects a magnified image onto a monitor, enabling the surgeon to precisely locate the polyp and its base of attachment. Surgical instruments are then passed through the hysteroscope to perform the removal.
Smaller polyps may be excised using specialized instruments like forceps or miniature scissors. Larger polyps are typically removed using a resectoscope, which employs an electrosurgical wire loop. This device shaves the polyp away from the uterine wall, allowing for simultaneous cutting and cauterization to control bleeding.
The surgeon removes the polyp at its base to ensure the entire growth is excised and minimize recurrence. The tissue fragments are collected and sent to a pathology laboratory for microscopic analysis. Once the procedure is complete, the instruments and fluid are withdrawn.
Immediate Recovery and Follow-Up Care
Hysteroscopic polypectomy is typically performed as an outpatient procedure, allowing most patients to return home within a few hours. Immediate post-operative experience includes mild to moderate cramping, similar to menstrual pain. Over-the-counter pain relievers, such as acetaminophen, are usually sufficient to manage this discomfort.
Light vaginal bleeding or spotting is normal and can persist for a few days up to a week. Patients should use sanitary pads instead of tampons to reduce infection risk. Avoid placing anything into the vagina, including sexual activity, for one to two weeks, or until advised by a healthcare provider.
Most individuals can resume light daily activities within 24 to 48 hours. Strenuous activity, such as heavy lifting or intense exercise, should be avoided for several days. A follow-up appointment is scheduled within a few weeks to ensure proper healing. Pathological analysis results are usually available within two to three weeks and are discussed at this visit.
Potential Complications and Recurrence
Hysteroscopic polypectomy has a low risk profile, but patients should be aware of rare potential complications. One risk is uterine perforation (a small tear in the uterine wall), which occurs in less than 1.7% of cases. Excessive bleeding or a pelvic infection are other uncommon complications requiring immediate medical attention.
A common concern after removal is recurrence, the possibility of polyps growing back. Recurrence rates vary widely (2.5% to 43.6%), depending on follow-up duration and patient risk factors. Factors that increase the likelihood of new polyps forming include advanced age, a higher body mass index, and having larger polyps initially.
Ongoing monitoring with routine gynecological exams is often recommended for those with identified risk factors or a history of multiple polyps. Hormonal therapies, such as a progestin-containing intrauterine device, may be discussed to manage hormonal stimulus and reduce future recurrence.