Uterine polyps, also known as endometrial polyps, are common tissue growths originating from the inner lining of the uterus (the endometrium). These overgrowths are typically noncancerous (benign) but frequently cause gynecological symptoms. Polyps range in size from a few millimeters to several centimeters, sometimes filling the uterine cavity. Their presence contributes to abnormal uterine bleeding and can interfere with fertility. Due to potential symptoms and a small chance of malignancy, removal is often recommended.
Identifying Uterine Polyps
The most common sign leading to the discovery of a uterine polyp is abnormal vaginal bleeding, a symptom present in approximately half of all symptomatic cases. This irregularity can manifest as bleeding between menstrual periods, unusually heavy menstrual flow, or spotting after intercourse. For women who have already gone through menopause, any vaginal bleeding warrants immediate medical evaluation. Polyps can also be a cause of infertility, as they may interfere with the implantation of a fertilized egg.
The initial diagnostic step is often a transvaginal ultrasound, which uses sound waves to create an image of the uterus and its lining. While this method can suggest the presence of a polyp by showing a thickened endometrium, a more definitive view is usually needed. Saline infusion sonography (SIS), or sonohysterography, is a specialized ultrasound where sterile saline solution is gently introduced into the uterine cavity. This fluid distends the cavity, allowing the polyp to be clearly outlined against the liquid, significantly improving diagnostic accuracy.
The most precise diagnostic method is hysteroscopy, where a thin, lighted telescope is inserted through the cervix for direct visualization of the uterine cavity. Hysteroscopy permits the physician to confirm the polyp’s exact size, location, and attachment point. Although SIS is highly accurate, hysteroscopy remains the gold standard because it allows for immediate biopsy or removal.
Non-Surgical and Conservative Management
Not every polyp discovered requires immediate surgical intervention, especially if the patient is premenopausal and asymptomatic. A strategy known as “watchful waiting” or expectant management is often recommended for small polyps, typically those under 10 millimeters in diameter. In these cases, there is a possibility that the polyp may resolve spontaneously without medical treatment.
For women experiencing symptoms, hormonal therapies, primarily using progestins, may be employed to manage the associated abnormal bleeding. These treatments work by counteracting the effects of estrogen, the hormone responsible for stimulating the endometrial growth that leads to polyp formation. Progestins help stabilize the uterine lining and reduce bleeding, but they are not an effective method for eliminating an existing polyp. For women with an increased risk of recurrence, a levonorgestrel-releasing intrauterine system may be used, which delivers progestin directly to the uterine lining and acts as a preventative measure.
Surgical Removal Procedures
The definitive treatment for removing uterine polyps is hysteroscopic polypectomy, a minimally invasive procedure. This technique allows for the complete removal of the polyp under direct visualization, ensuring that the base of the growth is fully excised. The procedure is typically performed on an outpatient basis and begins with the insertion of a hysteroscope, a slender instrument equipped with a camera and light, through the vagina and cervix into the uterus.
Once the hysteroscope is in place, the uterine cavity is distended with a fluid medium, such as sterile saline or glycine, to enhance the view of the endometrium. The physician carefully examines the uterine wall to locate the polyp, which may be attached by a thin stalk or a broad base. Specialized instruments are then passed through the working channel of the hysteroscope to remove the tissue.
For smaller polyps, a simple grasper or specialized scissors may be used to detach the growth from the uterine wall. Larger or multiple polyps often require a more advanced electrosurgical device like a resectoscope or a mechanical device called a hysteroscopic morcellator. The resectoscope uses an energized wire loop to shave the polyp from its base, simultaneously cauterizing the tissue to control bleeding. In contrast, the morcellator uses a rotating blade to cut the polyp into small fragments, which are then immediately suctioned out of the uterus. Following removal, the tissue is always sent to a pathology lab for microscopic examination to confirm whether the growth was benign or contained cancerous cells.
Recovery and Monitoring for Recurrence
Hysteroscopic polypectomy is considered a low-risk procedure, and most patients return home shortly after completion. It is common to experience mild lower abdominal cramping, comparable to menstrual cramps, for a few hours or days following the removal. Light vaginal spotting or bleeding is also expected and should gradually diminish over a few days, though it can last up to two weeks.
Patients are advised to avoid placing anything into the vagina, including tampons and sexual intercourse, for up to two weeks to reduce the risk of infection. Most individuals can resume their normal daily activities, including light exercise, within 24 hours. A follow-up appointment is necessary to discuss the final pathology results and plan for long-term monitoring.
While the procedure is highly effective in resolving symptoms, there is a chance for new polyps to develop, with recurrence rates ranging between 2.5% and 15% over several years. Patients who had polyps larger than 15 millimeters or who were experiencing abnormal uterine bleeding are at an elevated risk for recurrence. Regular gynecological check-ups and prompt reporting of any new abnormal bleeding are important for early detection.