Uterine polyps are abnormal growths that occur in the lining (endometrium) of your uterus. Women, in their 40s and 50s, who are approaching menopause (perimenopause), are most likely to develop polyps. They rarely affect women under 20 years old.
Polyps are usually round or oval and range in size from a few millimetres to a few centimetres (the size of a golf ball) or larger. They are usually noncancerous (benign) but can cause heavy periods (menorrhagia) or infertility if left untreated. Around 5% of polyps are cancerous.
The most common procedure to remove polyps is a hysteroscopy. During this procedure, a hysteroscope is inserted into your uterus (womb) through the vagina. This provides your surgeon with a clear view of your cervix and uterus and special instruments can then be used to remove any polyps.
What Causes Uterine Polyps?
The exact cause of uterine polyps is not known but researchers believe that being exposed to high levels of the female hormone, oestrogen may be a factor. Oestrogen plays a role in causing the endometrium to thicken each month during your menstrual cycle. Polyps are likely to develop because of this thickening.
What Are The Symptoms Of Uterine Polyps?
The most common symptom of uterine polyps is abnormal menstrual bleeding. Abnormal bleeding includes vaginal bleeding after menopause and irregular menstrual periods.
The symptoms of uterine polyps may include:
- Irregular menstrual periods (that do not follow the normal predictable monthly cycle)
- Unusually heavy periods (heavy menstrual bleeding)
- Bleeding or spotting between periods (intermenstrual bleeding)
- Infertility (unable to become pregnant or miscarry before term)
- Vaginal spotting or bleeding after menopause
- Bleeding after sex
Who Is At Risk Of Developing Polyps?
Age is a major risk factor for developing polyps. Women in their 40s and 50s, who are approaching menopause, are most likely to develop uterine polyps. Polyps that occur after menopause should be monitored for signs of cancer.
Your chance of developing uterine polyps also increases if you:
- Are overweight or obese.
- Have high blood pressure.
- Take tamoxifen, a drug that is used to treat breast cancer.
- Take hormone replacement therapy that includes a high dosage of oestrogen.
- Have Lynch syndrome or Cowden syndrome.
How Are Polyps Diagnosed?
Your doctor will first review your medical history and discuss your symptoms. To begin, your doctor is likely to perform a gynaecological exam, including a pelvic exam and a Pap smear. Based on these results, you might be referred for additional tests or procedures to confirm if polyps are present. These tests include:
A slim, handheld device is placed into the vagina which uses sound waves to produce an image of the inside of your uterus. This image will show any irregularities that may be present, such as a polyp or thickened endometrial tissue.
This procedure can be used in conjunction with a transvaginal ultrasound to improve the results.
During this procedure, a saline solution (salt water) is injected into the uterus through a small tube placed through the vagina and cervix. The saline expands the uterus, which provides a clearer view of the inside of the uterus during the ultrasound.
A hysteroscope is a narrow tube or telescope with a light and camera at the end that enables your doctor to clearly see your cervix and uterus. If any pathology is seen, special slender tools can be inserted through the hysteroscope to remove them.
A suction catheter is inserted into the uterus to collect a specimen for lab testing. The tissue sample of the removed polyp is analysed for signs of cancer.
How Are Polyps Treated?
Treatment will depend on your symptoms and any factors that may increase your chances of developing uterine cancer.
If the polyp is not causing symptoms, and you are still in your reproductive years, your doctor might suggest monitoring it to see if it goes away on its own. You are more likely to need treatment if you have gone through menopause or if your polyps are causing symptoms.
Treatment for uterine polyps might involve:
Small polyps without symptoms might resolve on their own. Treatment of small polyps is unnecessary for those who are not at risk of uterine cancer.
Certain hormonal medications, including progestins and gonadotropin-releasing hormone agonists, may reduce symptoms of the polyp. However, taking these medications is usually a short-term solution as symptoms usually recur once the medicine is stopped.
A hysteroscopy is a minimally invasive procedure that can be done under either local or general anaesthetic. You will normally be able to go home the same day.
During a hysteroscopy, instruments are inserted through the hysteroscope to remove any polyps. The removed polyp is usually sent to a lab for examination.
The outcomes associated with uterine polyp removal are excellent with women reporting an improvement of symptoms in 75% to 100% of cases. Polyps seldom grow back after removal.
Recovering From Surgery
Most women are able to return to their normal activities within one day. If you had a general anaesthetic, you may need a few extra days to recover.
While you are recovering you may experience cramping, which feels like period pain, and some spotting or bleeding for a few days. You should not have sex for a week, or until any bleeding has stopped. This reduces the risk of infection.