Uterine polyps are common growths that develop within the inner lining of the uterus, known as the endometrium. While typically non-cancerous, the decision to remove them depends on factors like symptoms, fertility concerns, and the small risk of malignancy. Understanding their nature helps individuals and healthcare providers make informed management decisions.
What Uterine Polyps Are
Uterine polyps, also called endometrial polyps, are overgrowths of cells in the endometrial lining that project into the uterine cavity. They can vary considerably in size, ranging from a few millimeters to several centimeters. These growths can attach to the uterine wall by a broad base (sessile) or a thin stalk (pedunculated).
Many individuals with uterine polyps experience no symptoms, but when symptoms do occur, abnormal uterine bleeding is the most frequent presentation. This can manifest as irregular menstrual periods, heavy menstrual flow, or bleeding between periods. Post-menopausal bleeding or spotting is also a common symptom that prompts investigation.
Diagnosis of uterine polyps often begins with imaging techniques such as transvaginal ultrasound. To enhance visibility, saline infusion sonography (SIS) may be performed, involving the injection of sterile saline into the uterus to expand the cavity for a clearer view during ultrasound. Hysteroscopy offers a direct visual examination of the uterine interior by inserting a thin, lighted telescope through the cervix. Hysteroscopy combined with histopathology is considered a gold standard for evaluating abnormal uterine bleeding and confirming polyps.
When Removal is Recommended
The recommendation for uterine polyp removal often stems from the presence of symptoms, particularly abnormal bleeding. Polyps can cause irregular, heavy, or prolonged menstrual bleeding, as well as spotting between periods or after menopause. Removing these symptomatic polyps can alleviate such bleeding patterns, significantly improving a person’s quality of life.
For individuals attempting to conceive, uterine polyps can interfere with fertility. Polyps may hinder the implantation of an embryo into the uterine lining or increase the risk of miscarriage. Their removal may improve the chances of successful conception and pregnancy outcomes by creating a more hospitable environment for implantation.
Another consideration for removal is the potential for malignancy, although most uterine polyps are benign. A small percentage, around 0.5% to 5%, can be cancerous or precancerous. The risk of malignancy is higher in postmenopausal individuals, particularly those experiencing abnormal bleeding. Pathological examination of the removed polyp tissue is crucial to rule out any cancerous cells. Factors that might increase suspicion for malignancy and prompt removal include larger polyp size, rapid growth, or atypical appearance on imaging.
How Polyps are Removed
The most common method for removing uterine polyps is hysteroscopic polypectomy. This minimally invasive surgical procedure involves inserting a thin, lighted telescope, called a hysteroscope, through the vagina and cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity directly, identifying the polyps.
Once visualized, specialized instruments are passed through the hysteroscope to grasp and remove the polyp. This procedure is typically performed as an outpatient day case, meaning patients usually go home the same day. Anesthesia options can range from local to regional or general anesthesia, depending on the complexity of the case and patient preference.
After the polypectomy, patients can expect some mild cramping, similar to menstrual pain, and light vaginal bleeding or spotting for a few days. These discomforts are generally manageable with over-the-counter pain relievers. The removed polyp tissue is always sent to a laboratory for pathological examination to confirm its nature and rule out any malignant changes.
Non-Surgical Approaches to Polyps
For some individuals, particularly those with small, asymptomatic uterine polyps, a non-surgical approach of “watchful waiting” may be recommended. In these cases, where there are no symptoms like abnormal bleeding and no concerns regarding fertility or malignancy, healthcare providers may choose to monitor the polyps with regular imaging, such as ultrasound. This approach acknowledges that some small polyps may regress or disappear on their own.
Medical management can also be considered to address symptoms rather than to eliminate the polyps themselves. Hormonal medications, such as progestins or gonadotropin-releasing hormone agonists, may be prescribed. These medications can help to regulate hormonal balance and reduce abnormal bleeding associated with polyps. However, this is often a short-term solution, as symptoms typically return once the medication is discontinued.