Uterine polyps are common, typically benign growths that originate from the inner lining of the uterus (endometrium). These growths are attached to the uterine wall and extend inward into the uterine cavity. While most polyps are noncancerous, they often cause symptoms like abnormal bleeding, which necessitates their removal.
Identifying Uterine Polyps and When Removal is Necessary
Symptoms such as abnormal uterine bleeding, including spotting between periods or heavy flow, often suggest the presence of uterine polyps. Postmenopausal bleeding (any vaginal bleeding after menopause) is also a common indicator requiring investigation. Polyps may also contribute to difficulty conceiving or recurrent miscarriage by interfering with implantation or blocking the fallopian tubes.
Initial investigation often begins with a transvaginal ultrasound. To achieve a clearer view of the uterine lining, saline infusion sonography (SIS) may be performed. This involves injecting sterile saline into the uterus to expand the cavity, allowing polyps to be clearly outlined during the ultrasound.
A definitive diagnosis is achieved with a diagnostic hysteroscopy, where a thin, lighted scope is inserted through the cervix to directly view the inside of the uterus. Removal is generally recommended for symptomatic polyps, those larger than one centimeter, or for any polyp found in a postmenopausal patient due to a slightly increased risk of malignancy.
Detailed Overview of Surgical Removal Techniques
The standard and most effective method for removing uterine polyps is hysteroscopic polypectomy. This procedure is typically performed in an outpatient setting, allowing the patient to go home the same day. Anesthesia can range from local numbing of the cervix to regional or general anesthesia.
The procedure begins with the gentle insertion of a hysteroscope, a thin, lighted telescope, through the vagina and cervix into the uterine cavity. To allow for better visualization, a fluid, such as saline, is continuously circulated through the hysteroscope to slightly expand the uterine walls.
Once the polyp is clearly visualized, specialized surgical instruments are passed through the working channel of the hysteroscope to remove the growth. Smaller polyps can often be removed using simple grasping forceps or small electrosurgical loops.
For larger or multiple polyps, a specialized device called a hysteroscopic morcellator or resectoscope is often used. The morcellator cuts the polyp into small fragments and suctions the tissue out of the uterus. The resectoscope uses a wire loop to shave off the polyp from the endometrial lining.
The primary advantage of hysteroscopic polypectomy is its precision, which minimizes damage to the surrounding healthy endometrial tissue. This careful removal is important for patients who wish to maintain or improve their fertility potential. The tissue specimen is collected and sent to a pathology lab for analysis.
What to Expect During Recovery and Follow-Up Care
Recovery following hysteroscopic polypectomy is generally quick, with most patients returning to their normal activities within one to two days. It is common to experience mild cramping, similar to menstrual discomfort, which can usually be managed with pain relievers.
Light vaginal spotting or bleeding is expected and can persist for a few days to two weeks after the procedure. To prevent infection, patients are typically advised to avoid placing anything into the vagina, including tampons and sexual intercourse, for at least one to two weeks.
Patients are also usually advised to refrain from heavy lifting or strenuous exercise for about one to two weeks, allowing the internal surgical site to heal completely. A follow-up appointment is generally scheduled within one to two weeks to assess healing and discuss the results of the pathology report.
The pathology report confirms the tissue analysis. If the pathology reveals any precancerous or cancerous cells, the physician will discuss further treatment options, though this is rare. This follow-up ensures the procedure was successful and provides an opportunity to discuss any concerns about future recurrence.
Non-Surgical Management Options
For small polyps, typically those under one centimeter, and for patients who are not experiencing any symptoms, a strategy of watchful waiting is often employed. This involves monitoring the polyp over time, as some small polyps can spontaneously regress or resolve on their own.
This observational approach involves follow-up imaging scheduled at regular intervals to track the polyp’s size. Watchful waiting is often preferred for premenopausal patients who are not trying to conceive or for those with high surgical risk.
Hormonal therapies, such as progestins or gonadotropin-releasing hormone agonists (GnRH agonists), are sometimes used to manage the symptoms associated with polyps. These medications can temporarily regulate the menstrual cycle and reduce bleeding by counteracting the estrogen-driven growth of the endometrium. However, these drug therapies are not considered curative, as symptoms often return once medication is stopped.