Uterine polyps are common growths that develop in the inner lining of the uterus, known as the endometrium. These growths extend into the uterine cavity and can vary in size, from a few millimeters to several centimeters. While typically benign, some polyps may contain precancerous or cancerous cells. Understanding their nature and removal methods is important for managing symptoms and health concerns.
Indications for Uterine Polyp Removal
Uterine polyps do not always cause symptoms; some individuals may have polyps without realizing it. However, when symptoms occur, they often involve abnormal uterine bleeding, such as heavy menstrual periods, bleeding or spotting between periods, or any vaginal bleeding after menopause.
Beyond bleeding irregularities, uterine polyps can also impact fertility. They may interfere with a fertilized egg’s ability to implant in the uterine wall or increase the risk of miscarriage. Polyps are sometimes discovered during infertility investigations, even if no bleeding symptoms are present. While most uterine polyps are benign, a small percentage (0.5% to 5%) can be cancerous or precancerous. The risk of malignancy is slightly higher in postmenopausal individuals and those experiencing abnormal bleeding, which often prompts removal for pathological examination.
Pre-Procedure Steps and Diagnosis
Before polyp removal, a healthcare provider conducts an initial consultation, including a review of medical history and a physical examination. Diagnosis usually begins with imaging techniques to visualize the uterine cavity. A common first step is a transvaginal ultrasound, where a slender device is inserted into the vagina to generate images of the uterus and its lining.
To obtain a clearer view and confirm polyps, saline infusion sonohysterography (SIS) may be performed. This involves injecting sterile saline solution into the uterus to gently expand the cavity, outlining growths more distinctly during an ultrasound. Another diagnostic approach is hysteroscopy, where a thin, lighted telescope is inserted through the vagina and cervix into the uterus, allowing direct visualization of the polyps. An endometrial biopsy, collecting a tissue sample from the uterine lining, may also be performed to analyze cells for abnormalities. These diagnostic steps help determine the size, number, and location of polyps, informing the best course of treatment.
Techniques for Polyp Removal
The primary method for removing uterine polyps is hysteroscopic polypectomy, a minimally invasive surgical procedure. This technique involves inserting a hysteroscope, a thin tube with a light and camera, through the vagina and cervix into the uterus. The hysteroscope transmits images of the uterine interior to a monitor, providing the surgeon with a clear, magnified view of the polyps.
Once identified, specialized instruments are passed through the hysteroscope to carefully detach and remove them. These instruments may include graspers, scissors, or an electrical loop (resectoscope) designed to cut the polyp from its base. The procedure allows for precise removal while minimizing damage to the surrounding uterine tissue. The removed tissue is sent to a pathology laboratory for microscopic examination to confirm its benign nature or identify any cancerous or precancerous cells. While dilation and curettage (D&C) was historically used, hysteroscopic polypectomy is often preferred due to its direct visualization, ensuring more complete removal and reducing the chance of missing polyps.
Post-Procedure Recovery
Following hysteroscopic polypectomy, patients typically experience a quick recovery. Light vaginal bleeding or spotting, lasting a few days to a couple of weeks, is common, along with mild cramping or discomfort similar to menstrual cramps. Pain medication can help manage any discomfort experienced during this period. Many individuals can resume their normal daily activities within a day or two after the procedure.
To promote healing and reduce the risk of infection, specific post-procedure guidance is usually provided. This often includes avoiding tampons, douching, and sexual intercourse for a specified period, typically a week or two. Patients are advised to contact their healthcare provider if they experience heavy bleeding, severe pain, fever, or unusual discharge. A follow-up appointment is often scheduled to review the pathology results of the removed polyp and discuss any further care or monitoring that may be necessary.