Uterine Polyps

Uterine polyps, or endometrial polyps, are the growth of cells that arise from the inner wall of the uterine lining and hang from the uterine wall. These polyps are usually benign, but they can become cancerous. But some polyps may also turn cancerous and are known as precancerous polyps.

 

Causes 

Uterine polyps are not known to have an exact cause. But the most likely factor causing these polyps is hormonal changes. Oestrogen promotes the growth of the uterine lining every month and therefore is linked to the growth of the polyps.

 

Signs and symptoms 

1. Irregular menstrual bleeding – your blood flow during the period and your cycle length is variable 
2. Excessively heavy bleeding during periods
3. Bleeding between two menstrual cycles
4. Vaginal bleeding after menopause
5. Infertility
6. Some women may experience very light bleeding or spotting, while others may be symptom-free.

 

Diagnosis 

Uterine polyps are diagnosed based on primarily the patient’s history and clinical investigations: 

1. Patient history

This comprises your menstrual history. Your doctor will ask you about how long your periods usually last, how often you get your menstrual cycle, and any other symptoms that may be present. If you are trying to conceive, the doctor will inquire about any difficulties or other issues you may be facing.

2. Clinical examination

The gynaecologist will perform an internal exam to check for obvious bleeding or low-hanging polyps.

3. Investigations

Investigations for uterine polyps may include:

Transvaginal ultrasound 

This procedure involves a sonogram of the internal part of the uterus. The doctor inserts a probe into the vagina and captures the ultrasound image.

Hysteroscopy

This helps diagnose and treat uterine polyps. This involves inserting a long, thin tube into the vagina and viewing the uterus from the inside through the hysteroscope.

Sonohysterography

This procedure may be performed after transvaginal ultrasound. Sterile fluid is inserted into the uterus through the catheter, which makes the uterus expand and provide a solid image of the uterine cavity.

Endometrial biopsy

The polyp is removed from the uterus and sent as a specimen to the lab for testing. Endometrial biopsy helps diagnose uterine polyps. In some cases, the doctor may miss removing the polyp out.

Curettage

This procedure is used to diagnose as well as treat uterine polyps. The doctor will insert a hysteroscope into your uterine cavity and check for polyps. The polyps are scraped along with the uterine lining and sent for testing. 

 

Treatment 

Uterine polyps are not treated most of the time, since they do not show up with many symptoms. However, if you have any heavy bleeding or pain during your periods, you must get yourself checked. In case the polyps become cancerous, you will need to get them removed. 

There are four treatment protocols:

1. Medications

Medicines containing progestins and gonadotropin-releasing hormone agonists help maintain the hormonal balance in your body. These medicines may provide temporary relief from the symptoms. However, once you stop the medicine, your symptoms may return. 

2. Curettage

This procedure involves using a hysteroscope to look inside your uterine cavity and check for polyps. The gynaecologist will then scrape the uterine lining and remove the polyps. Think of it like a cleaning process. The polyps are sent to be checked in the laboratory to determine if they are benign or cancerous. 

3. Hysteroscopy 

An instrument called a hysteroscope is used to look inside your uterus. The hysteroscope helps visualise if there is any growth in the uterine cavity. Once the exact location of the polyps is identified, the doctor then inserts surgical instruments to remove them.

4. Hysterectomy

In cases where the above methods are not helpful in removing the polyps and they become cancerous, then the entire uterus is removed. This surgical procedure is known as hysterectomy.

 

The benefits of treatment for uterine polyps are

1. Removal of Uterine polyps helps pregnant carry a pregnancy to term and may also be signs that uterine polyps are present.
2. Other symptoms include prolonged or excessive menstrual bleeding (menorrhagia), bleeding between periods, and bleeding after menopause or sexual intercourse.

Risks if not treated in time 

1. Complications of uterine polyps include:  
2. Infertility – Polyps prevent you from getting pregnant or may increase your chances of miscarriage by preventing the fertilized egg from attaching to the uterine lining or blocking the cervix or your fallopian tubes. 

1. Consult your gynaecologist when you experience any symptoms, like heavy bleeding, increased bleeding, bleeding between your periods, or difficulty in conceiving.  
2. Your gynaecologist will enquire about your medical history, family history, and sexual history. 
3. You may need to get a series of tests done for the physician to understand your clinical condition. 
4. Sort your queries with your gynaecologist regarding the status of your polyp. Most polyps do not require treatment, and hence, you just need to wait. Clarify with your doctor what signs you need to be wary of and when you need to consult in case of an emergency.