Uterine polyps are non-cancerous growths that develop on the inner lining of the uterus, known as the endometrium. These growths can vary in size, from a few millimeters to several centimeters, and may be single or multiple. While often benign, their detection is important because they can lead to symptoms such as abnormal vaginal bleeding, including spotting between periods or heavy menstrual flow, and may also impact fertility.
Methods for Detecting Uterine Polyps
Transvaginal ultrasound (TVUS) is often the initial imaging tool used to evaluate the uterus. This procedure involves placing a slender, wand-like device, called a transducer, into the vagina. The transducer emits sound waves that create images of the uterus, including its inner lining, which can reveal areas of thickened endometrial tissue or show the presence of a polyp.
Saline infusion sonography (SIS), also known as sonohysterography, offers a more detailed view of the uterine cavity than transvaginal ultrasound. During SIS, a thin catheter is inserted through the cervix, and saline solution is injected into the uterus. This saline distends the uterine cavity, allowing for clearer visualization of the endometrial lining and any polyps, as the fluid outlines them. SIS improves diagnostic accuracy for endometrial polyps compared to TVUS alone.
Hysteroscopy involves inserting a thin, flexible, lighted telescope, called a hysteroscope, through the vagina and cervix into the uterus. This allows for direct visualization of the uterine cavity, enabling identification and assessment of polyps. Hysteroscopy is not only a diagnostic tool but can also be used to remove polyps during the same procedure.
An endometrial biopsy involves taking a tissue sample from the uterine lining for laboratory analysis. This procedure typically uses a thin tube or suction catheter inserted through the cervix to collect tissue. While a biopsy can confirm the presence of uterine polyps, it is a blind procedure and may miss the polyp, especially if it is small or hard to reach.
Preparing for and Undergoing Tests
Before undergoing tests for uterine polyps, discuss your symptoms and medical history with your healthcare provider. You may be asked about any medications you are currently taking and your menstrual cycle patterns. For procedures like saline infusion sonography or hysteroscopy, timing relative to your menstrual cycle is often considered; the first week after your period ends is generally optimal for clearer visualization.
During a transvaginal ultrasound, you will lie on an exam table, similar to a pelvic exam. The transducer, which is smaller than a standard speculum, is inserted into the vagina. The procedure is generally quick and often causes minimal discomfort. For a saline infusion sonography, a thin catheter is inserted, which may cause mild cramping as saline is introduced to distend the uterus.
If you are undergoing a hysteroscopy, the procedure might involve local or general anesthesia, depending on the setting and whether polyps will be removed. You may experience mild cramping or pressure as the hysteroscope is inserted and the uterus is distended with fluid or gas. Most hysteroscopies are outpatient procedures, allowing you to go home the same day. After any of these procedures, it is common to experience mild cramping and light spotting for a few days.
Interpreting Test Results and Next Steps
After your tests, results are communicated by your healthcare provider within a few days to a week, though more complex cases, such as those involving biopsy analysis, might take longer. If uterine polyps are diagnosed, your provider will explain what this means. Most uterine polyps are benign, meaning they are not cancerous.
However, in some cases, polyps can have precancerous changes or, rarely, contain cancerous cells, particularly in postmenopausal women or those with certain risk factors. Based on the test findings, your doctor will discuss potential next steps. Options may include monitoring the polyps, especially if they are small and not causing symptoms, or considering medication to manage symptoms.
Often, surgical removal of the polyps via hysteroscopy is recommended, particularly if they are causing bothersome symptoms like abnormal bleeding or impacting fertility. The removed tissue will be sent for lab analysis to confirm the diagnosis and check for any abnormal cells. Have an open discussion with your healthcare provider to understand the results and determine the best course of action.