Uterine polyps and fibroids are common gynecological conditions that often present with similar symptoms, making precise diagnosis challenging. Polyps are soft, abnormal growths arising from the endometrium (the inner lining of the uterus). Fibroids are dense, non-cancerous tumors composed of the muscular tissue of the uterine wall. Although both are generally benign, they can cause significant health concerns, requiring a structured diagnostic process to differentiate them and rule out malignancy.
Symptoms That Prompt Diagnostic Testing
Abnormal uterine bleeding is the most frequent symptom prompting evaluation for a potential polyp or fibroid. This bleeding can manifest as excessively heavy or prolonged menstrual periods, known as menorrhagia, or as irregular spotting between cycles. Patients may also experience bleeding after menopause, which requires immediate investigation to exclude serious pathology.
Beyond changes in menstrual flow, other symptoms can include chronic pelvic pressure or pain, often more pronounced with larger fibroids. Gastrointestinal polyps, which are growths found in the colon or rectum, cause different symptoms. These may include unexplained iron-deficiency anemia from slow blood loss or a noticeable change in regular bowel habits.
Initial Imaging and Non-Invasive Screening
The diagnostic process begins with a comprehensive patient history and a physical examination, including a pelvic exam to check for an enlarged uterus or palpable masses. The first-line, least invasive method for assessing the uterus is the transvaginal ultrasound (TVUS). TVUS uses a slender probe to create detailed images of the pelvic organs, identifying the presence, size, and location of masses within the uterus.
A standard TVUS may struggle to definitively distinguish a small submucosal fibroid, which bulges into the uterine cavity, from an endometrial polyp. If a gastrointestinal source of bleeding is suspected, screening involves non-invasive methods like the fecal immunochemical test (FIT), which detects hidden blood in the stool. Specialized procedures are typically needed for a definitive diagnosis and tissue characterization.
Specialized Procedures for Polyp Confirmation
To achieve a conclusive diagnosis of a uterine polyp, hysteroscopy is often utilized for direct visualization of the uterine cavity. A thin, lighted telescope (hysteroscope) is inserted through the cervix, and saline is introduced to gently distend the uterine walls, providing a clear view of the endometrial lining. This direct observation confirms the polyp’s presence, attachment point, and appearance, which is important for ruling out malignancy.
During hysteroscopy, the polyp can often be removed entirely in a procedure called a hysteroscopic polypectomy, or a tissue sample can be taken for laboratory analysis. Pathological analysis, where the tissue is examined under a microscope, is the definitive final step to confirm the diagnosis and ensure the growth is benign. For polyps in the gastrointestinal tract, a colonoscopy or sigmoidoscopy serves a similar function, allowing a physician to visually inspect the colon, confirm the presence of polyps, and remove them for histological examination.
Specialized Procedures for Fibroid Confirmation
When initial imaging suggests a uterine mass, Saline-Infusion Sonography (SIS), also known as hysterosonography, is frequently employed to clarify the diagnosis. This method involves injecting sterile saline solution into the uterine cavity, which expands the space and provides acoustic contrast. The fluid highlights masses that are free-floating in the cavity, such as polyps, and clearly delineates submucosal fibroids embedded in the muscular wall.
For complex cases or when extensive surgical planning is necessary, Magnetic Resonance Imaging (MRI) is the most comprehensive non-invasive imaging tool. MRI provides superior soft-tissue contrast and detailed images that accurately map the size, number, and specific location of fibroids, such as intramural (within the wall) or subserosal (on the outer surface). This detailed mapping is useful before major procedures like uterine artery embolization or complex myomectomy.