Uterine polyps are common, non-cancerous growths that develop from the endometrium, the inner lining of the uterus. These growths are typically benign, but they can significantly affect a person’s quality of life and reproductive health. Treatment is often necessary to resolve persistent symptoms, address fertility concerns, or rule out the rare possibility of malignancy. The decision to remove a polyp depends on its size, the symptoms it causes, and the patient’s overall health goals.
Defining Uterine Polyps and When Intervention is Necessary
Uterine polyps, also known as endometrial polyps, are localized overgrowths of the endometrial tissue, forming a structure that attaches to the uterine wall by a thin stalk or a broad base. They range in size from a few millimeters to several centimeters. It is important to distinguish polyps from uterine fibroids, which are dense, muscular tumors that grow in or on the uterine wall, rather than originating from the lining.
The primary reason for intervening is the presence of abnormal uterine bleeding (AUB), which can manifest as irregular menstrual periods, bleeding between cycles, or unusually heavy flow. Polyps are also a frequent cause of bleeding after menopause, which always warrants investigation due to the increased risk of cancer in postmenopausal polyps. Furthermore, polyps can interfere with fertility by impeding the implantation of an embryo. Diagnosis often occurs during routine imaging, such as a transvaginal ultrasound or a more detailed saline infusion sonohysterography.
Non-Surgical and Expectant Management
For small, asymptomatic polyps, especially in pre-menopausal individuals, expectant management is a common initial approach. This involves watchful waiting, as some small polyps may regress or disappear on their own. This observation period is suitable only when the polyp is non-suspicious and the patient is not experiencing abnormal bleeding or seeking to become pregnant.
Hormonal medications such as progestins or gonadotropin-releasing hormone agonists are prescribed to manage symptoms. These medications regulate hormone levels, temporarily reducing abnormal bleeding. However, they are considered a short-term solution because they rarely cause established polyps to fully resolve. Symptoms often return once medication stops, making surgical removal the more definitive option for long-term relief.
Procedural Removal Methods
The most effective and common way to remove uterine polyps is through a minimally invasive procedure called hysteroscopic polypectomy. This technique allows for precise removal under direct visualization, ensuring the entire polyp, including its base, is excised. A hysteroscope, a thin tube equipped with a camera and light, is inserted through the vagina and cervix into the uterine cavity.
To optimize visualization, a fluid, such as saline, is continuously infused into the uterus to expand the cavity. Once the polyp is located, specialized instruments are passed through the hysteroscope to remove it. These instruments include grasping forceps, scissors, or a resectoscope, which uses an electrosurgical wire loop to slice the polyp away. A morcellator, a device that simultaneously cuts and suctions tissue, is also used for efficient removal, especially for larger polyps.
The ability to see the uterine cavity clearly is a significant advantage of hysteroscopy. It allows the surgeon to confirm the complete removal of the polyp and its attachment site, which reduces the risk of recurrence. This visualization also ensures the tissue sample is intact for pathological analysis to check for abnormal cells.
Dilation and curettage (D&C) is an older method that involves scraping the uterine lining without direct visualization. D&C is less preferred today because it is considered a blind procedure. It carries a higher risk of missing the polyp or leaving a portion of its base behind, leading to higher recurrence rates compared to hysteroscopy.
Recovery and Monitoring for Recurrence
Following hysteroscopic polypectomy, recovery is typically rapid, and the procedure is usually performed on an outpatient basis. Patients may experience mild cramping similar to menstrual discomfort, along with light vaginal bleeding or discharge for a few days to a week. Most individuals return to their normal daily activities within twenty-four hours, though strenuous activity is restricted for a short period.
The removed tissue is always sent to a laboratory for analysis to confirm the benign nature of the growth and rule out pre-cancerous or cancerous changes. While the procedure is highly effective, new polyps may develop over time, with recurrence rates estimated to be low. Follow-up monitoring, often involving repeat transvaginal ultrasounds, may be recommended to ensure no new polyps have formed.