A polyp of the uterus or endometrium is an unnatural proliferation of the endometrial cells that settles on the inner wall of the uterus.
As a rule, it is a benign tumor, but since it can become malignant, regular check-ups must be carried out.
Uterine polyps are formed by excessive cell division; they represent recurrent formations that require various treatments.
At the first signs of an abnormal menstrual period or discomfort in the pelvic region, a doctor should be consulted immediately because of the risks and complications that uterine polyps can bring.
The size of the polyps ranges from a few millimeters to several centimeters.
As a rule, they adhere to the wall of the uterus with a wide contact surface or are attached there in the form of a thin stem.
Uterine polyps can occur singly or multiple times.
Usually they are confined to the inside of the uterus, but in rare cases they can also slide out of the uterine opening (cervix) into the vagina.
Polyps form in a short time.
Usually, polyps are benign (not cancerous) tumors, but malignant polyps can also occur or benign polyps can become malignant tumors (precancerous polyps).
Are there risk groups?
The following factors increase the likelihood of developing uterine polyps:
- age between 40-50 years,
- menopause shortly before or just begun,
- taking anti-estrogen medications, such as Nolvadex (Tamoxifen).
What causes uterine polyps?
Why exactly the polyps form is unknown, but the fluctuations in hormone levels can be important.
Estrogens ensure the monthly build-up of the uterine lining and appear to play a role in the growth of uterine polyps.
What are the symptoms of uterine polyps?
Symptoms of polyps of the uterus include:
- irregular monthly cycles (delayed or premature),
- unusually heavy menstrual bleeding,
- strangely colored intermenstrual bleeding (polyps are supplied with blood vessels and can therefore bleed),
- light red or brown discharge,
- bleeding after menopause,
The most common symptoms of uterine polyps include irregular or unforeseeable menstrual bleeding.
A woman’s menstrual period usually lasts 4 to 6 days.
It usually occurs every 28 days, but a normal menstrual cycle can vary from 21 to 35 days.
About half of women with uterine polyps have irregular menstrual cycles.
Polyps of the uterus are the cause of unusual bleeding in 25% of these cases.
The inability to get pregnant or carry a pregnancy to term can also be a sign of polyps.
Infertility and uterine polyps
Infertility or sterility is defined when conception does not occur after at least one year of regular sexual intercourse.
According to the Jones Institute of Reproductive Medicine, a sterile woman who has no symptoms of uterine polyps has a 3-5% chance of having asymptomatic polyps.
With the occurrence of unusual bleeding, the likelihood of polyps is greater.
A polyp of the uterus can act like a natural intrauterine device (IUD) and prevent the fertilized egg from implanting in the uterine wall.
The junction between the fallopian tube and uterine cavity can also be blocked, so that the sperm cannot enter the fallopian tube and thus cannot meet the egg.
Likewise, the cervix may be blocked and prevent sperm from entering the uterus.
Polyps can play a role in miscarriage.
In a 2005 study published in the journal Human Reproduction, women who have been artificially inseminated after removal of polyps are twice as likely to become pregnant as women whose polyps have not been removed.
Women whose polyps have been removed often become pregnant without artificial insemination.
Diagnosis is usually made by curettage (scraping) and laboratory analysis of the removed tissue (histological examination) to determine whether it is a dangerous polyp.
Other diagnostic techniques:
- Transvaginal ultrasound: In this examination procedure, a narrow ultrasound head is inserted into the vagina.
The transducer emits sound waves that are reflected on the tissue layers and create an image of the inside of the uterus, which also shows any irregularities.
- Hysterography is an X-ray that shows the size and shape of the uterine cavity.
Endoscopy of the uterus (hysteroscopy) is an endoscopic examination procedure with which the uterine cavity and cervix can be viewed.
It can be used for diagnosis or therapy.
Taking and examining a tissue sample (biopsy) is important to rule out cancer.
- A Pap test is insufficient for the analysis of the polyp, because this examination procedure is limited to the control of the cervix.
Treatment of uterine polyps
For polyps of the uterus, the doctor may recommend the following forms of treatment:
Small polyps that do not cause symptoms, i.e. are asymptomatic, can disappear spontaneously. Treatment is unnecessary unless there is a risk of uterine cancer.
Certain hormone preparations, including progestins and GnRH agonists, can reduce uterine polyps and their symptoms.
These drugs are usually a short-term therapy solution, the symptoms usually reappear as soon as the medication stops.
When is it necessary to operate and remove the polyp?
The doctor will consider whether surgery is an option based on the existing symptoms, the presence of infertility and the histological examination results for cancer analysis of the cells.
How to remove a uterine polyp? Scraping or curettage
The doctor uses a long metal instrument with a ring at one end, which is used to scrape off the walls of the uterus.
In this way, a tissue sample can be taken or the polyp removed from the uterus (if it is smaller than about 2 cm).
The doctor can use a hysteroscope during curettage, which can be used to display the inside of the uterus before and after scraping.
The hysteroscopic procedure takes about 20 minutes, then the woman must stay in bed as long as the doctor sees fit.
General anesthesia can cause symptoms such as vomiting, nausea and drowsiness.
As a rule, it is a “light” general anaesthetic and the procedure is performed on an outpatient basis, i.e. the patient can return home on the day of the operation.
After the procedure
When the anaesthetic effect wears off, the patient will feel pain for a few days, but normal daily activities may be resumed the day after the procedure.
During convalescence, sexual intercourse must be abstained for about two weeks.
- uterine bleeding,
- difficulty urinating,
- severe abdominal cramps,
- increasing abdominal pain,
- strong-smelling discharge, which could indicate an infection.
In hysteroscopy, the identified polyps can be removed with the help of instruments inserted through the hysteroscope (medical device that indicates the inside of the uterus). Subsequently, the polyp can be examined microscopically in the laboratory.
If a polyp contains cancer cells, the doctor will explain the further procedure.
If uterine polyps recur, more than one treatment may be necessary.
The fertility and receptivity of the woman are preserved.
Polyps are often recurrent; to prevent relapses, doctors sometimes prescribe the contraceptive pill or the intrauterine device (IUD).