Unless you or someone close to you has been previously diagnosed with an endometrial polyp, you are likely to know what that is. These abnormal growths are common, with more than 200,000 cases per year in the United States alone.
This growth, which projects from the uterine lining, contains glands, supporting tissues and its own blood supply. Polyps can range in size anywhere from just a few millimeters up to a few centimeters and can occupy the entire uterus.
These growths are most frequently found on the fundus or the part of the uterus furthest from the vaginal opening. They are often asymptomatic; however, polyps occasionally form lower in the uterus, which can be problematic. If a polyp is low in the uterus or located on the cervix itself, it is likely to cause abnormal and excessively heavy menstrual bleeding.
Of the clinical characteristics, abnormal uterine bleeding is the most common symptoms of endometrial polyps. About 50% of abnormal uterine bleeding is traced back to these growths. Also, 35% of infertility cases are linked to a polyp diagnosis. That said once removed the chances of getting pregnant significantly improve. While these growths are generally benign, a small number of endometrial polyps are found to contain cancer.
Scientists are not sure what causes endometrial polyps. Some theories of polyp pathogenesis include hormonal imbalances and chromosomal abnormalities.
To diagnose polyps physicians generally turn to transvaginal ultrasonography (TVUS.) This imaging is done by inserting an ultrasound probe into the vagina, allowing doctors a view of the uterine cavity.
In other cases, doctors may notice polyps on inspection of the cervix either during routine check-ups or while attempting to locate the source of abnormal bleeding. When this is done, a sample is generally taken so that the polyp diagnosis may be confirmed microscopically. In comparison with normal endometrial tissue, microscopic examination of a polyp typically reveals supporting tissues and the growth’s blood supply. The gold standard, though for polyp diagnosis, is a sonohysterography.
Treatment for endometrial polyps can be sorted between three subdivisions. Because symptom-free polyps have a high regression rate and low chance of malignancy, conservative non-surgical treatment is most often recommended to asymptomatic women. Occasionally these women will be given hormones which may help shrink the polyps.
The second subcategory is conservative surgery. Hysteroscopy is widely considered the best surgical option for treating polyps. This outpatient procedure generally eliminates bleeding in patients. It is also unlikely that polyps removed via this method will reoccur. Once removed, these polyps can be evaluated for any presence of cancer. A second conservative surgical option is dilation and curettage, but this method is rarely used because of the likelihood a clinician might miss additional growths.
The third subcategory is only for extreme cases or cases where malignancy is detected. This may involve surgical removal of the entire uterus.
In the above video, Dr. Leena Shankar Nathan, from UCLA health, discusses endometrial polyps as well as the most common diagnostics and treatments.
Sources: UCLA Health, SAGE Journals, Mayo Clnic