Uterine polyps (endometrial polyps) are abnormal cell overgrowths that form in the endometrium, the inner lining of the uterus. These growths attach to the uterine wall, often by a thin stalk, and extend into the uterine cavity. Although most polyps are benign, they can cause disruptive symptoms and sometimes require removal. This article details the procedures used to remove uterine polyps and the expected recovery process.
Understanding When Removal is Necessary
The decision to remove a uterine polyp depends on whether it causes symptoms or presents specific risk factors. Many polyps are asymptomatic, and physicians may choose to simply monitor them. Removal is often recommended when a polyp causes abnormal uterine bleeding, such as heavy periods, spotting between cycles, or any bleeding after menopause. This abnormal bleeding is the most common symptom prompting treatment.
Polyps are also removed if they interfere with conception or cause recurrent miscarriage by disrupting the implantation of a fertilized egg. Diagnostic imaging, such as a transvaginal ultrasound or a saline infusion sonohysterography, confirms the polyp’s presence and location. Furthermore, removal is frequently recommended for postmenopausal women to rule out the small possibility of malignant or precancerous changes.
Surgical Procedures for Uterine Polyp Removal
The preferred method for removing uterine polyps is hysteroscopic polypectomy, a minimally invasive surgical procedure. This technique is the standard because it allows for direct visualization of the uterine cavity, ensuring precise and complete removal. The procedure involves inserting a thin, lighted instrument called a hysteroscope through the vagina and cervix into the uterus, avoiding external incisions. Fluid is infused through the scope to expand the cavity, providing a clear view of the uterine walls and the polyp.
Once the polyp is visible, specialized instruments are passed through the hysteroscope to perform the removal. These instruments may include grasping forceps, electrosurgical loops, or a hysteroscopic morcellator. A resectoscope, which uses an electrosurgical wire loop, is often used to shave the polyp away from the uterine wall at its base, sometimes applying cautery to control bleeding. Hysteroscopic polypectomy is typically performed as an outpatient procedure, allowing the patient to go home the same day.
A less precise method for polyp removal is Dilation and Curettage (D&C). This procedure involves dilating the cervix and using a curette, a spoon-shaped instrument, to scrape tissue from the uterine lining. D&C is performed blindly without direct visualization, making it less effective than hysteroscopy for ensuring the entire polyp is removed. D&C is often performed alongside hysteroscopy to clear tissues and gather samples for pathology.
Post-Procedure Recovery and Follow-up Care
Recovery from hysteroscopic polypectomy is generally quick, with most individuals returning home shortly after the procedure. Mild side effects are common in the first few days, including period-like cramping and light vaginal bleeding or spotting. Over-the-counter pain relievers, such as acetaminophen, usually manage any discomfort. Some patients may notice temporary gas pains radiating to the upper abdomen or shoulder, caused by the gas or fluid used to expand the uterus during the procedure.
Patients should take it easy for a few days and avoid strenuous activities or heavy lifting for up to two weeks. To allow the cervix and uterus time to heal and reduce infection risk, patients must refrain from using tampons and having sexual intercourse for one to two weeks, or as directed by the physician. Although most people feel better within a week, full internal healing of the uterine lining takes about two weeks.
A crucial component of post-procedure care is the pathological review of the removed tissue. The polyp is sent to a laboratory to be examined under a microscope. This confirms the growth is benign and checks for any abnormal or precancerous cells. A follow-up appointment is scheduled with the gynecologist to discuss the pathology results, monitor recovery, assess symptom resolution, and check for potential polyp recurrence.