Uterine polyps are common growths that develop from the endometrium, the tissue lining the inside of the uterus. They represent an overgrowth of this inner uterine layer. These growths are attached to the uterine wall by either a thin stalk or a broader base and extend inward into the uterine cavity. Polyps can vary significantly in size, ranging from a few millimeters to several centimeters. It is possible to have a single polyp or multiple polyps present.
Understanding How Common Uterine Polyps Are
Uterine polyps are common, although their true prevalence is difficult to pinpoint because many people with polyps have no symptoms. Estimates of prevalence among women range broadly, suggesting they are present in 10 to 24 percent of women undergoing certain procedures. The development of these growths is strongly associated with age, with the incidence rising significantly as women get older.
Polyps are most commonly found in women in their 40s and 50s, peaking around the time of perimenopause. They are substantially more frequent in postmenopausal individuals compared to those who are premenopausal. For instance, one study found polyps in 5.8 percent of premenopausal women and 11.8 percent of postmenopausal women.
The vast majority of uterine polyps, over 95 percent, are benign. However, a small percentage may be pre-cancerous or cancerous, with the risk being slightly higher in women who are postmenopausal. Malignancy in polyps is rare, occurring in only about 2.73 percent of cases overall.
Recognizing the Clinical Signs
When symptoms do occur, they are typically related to abnormal uterine bleeding (AUB) due to the polyp disrupting the normal shedding of the uterine lining. AUB is the primary indicator reported by symptomatic people.
The patterns of bleeding can manifest in several ways. One common sign is intermenstrual bleeding. Periods themselves may also be affected, often becoming irregular, heavier, or lasting longer than usual, a condition known as menorrhagia.
For women who have completed menopause, any vaginal spotting or bleeding is a significant clinical sign. Postmenopausal bleeding is a particularly important symptom that prompts investigation, as it can be an indicator of a polyp or other uterine conditions. Some people may also experience bleeding after sexual intercourse.
Methods of Medical Identification
The initial step in identifying a uterine polyp often begins with a transvaginal ultrasound (TVS). This procedure uses a wand placed in the vagina to generate images of the uterus, which can show a thickened endometrial lining or suggest the presence of a growth. However, TVS alone sometimes lacks the specificity needed to definitively distinguish a polyp from other endometrial thickening.
To improve visualization, a technique called saline infusion sonohysterography (SIS) is often performed. During SIS, saline solution is injected through the cervix into the uterine cavity. This fluid gently distends the uterine walls, outlining the polyp and allowing clear visualization of the growth. SIS is a highly effective, non-invasive method that improves diagnostic accuracy compared to standard TVS.
The definitive method for both diagnosis and often treatment is hysteroscopy. This procedure involves inserting a thin, flexible, lighted telescope, called a hysteroscope, through the vagina and cervix directly into the uterus. Hysteroscopy allows the physician to directly view the uterine lining and the polyp in real-time. Hysteroscopy is considered the gold standard for evaluating the uterine cavity.
Treatment Options and Management
Once a uterine polyp is identified, the recommended course of action depends on several factors, including the presence of symptoms, menopausal status, and the size of the polyp. For small, asymptomatic polyps, particularly in premenopausal women, watchful waiting may be recommended. These small growths may occasionally regress on their own.
Removal is generally advised if the polyp is causing symptoms such as abnormal bleeding, if the patient is postmenopausal, or if the polyp is large (greater than 10 millimeters). The standard treatment is hysteroscopic polypectomy. This surgical procedure is performed using instruments inserted through the hysteroscope, allowing the physician to precisely excise the polyp while directly viewing the uterine cavity.
The removed tissue is always sent to a pathology lab for histological review. This microscopic analysis is necessary to confirm that the polyp is benign and to rule out any pre-cancerous changes or malignancy. Hysteroscopic polypectomy is often performed as an outpatient procedure and is highly effective at resolving the symptoms.