Χάρης Χ. Χηνιάδης

An endometrial polyp or uterine polyp is a polyp or lesion in the lining of the uterus (endometrium) that takes up space within the uterine cavity. Commonly occurring, they are experienced by up to 10% of women. They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated). Pedunculated polyps are more common than sessile ones. They range in size from a few millimeters to several centimeters. If pedunculated, they can protrude through the cervix into the vagina.

Cause and symptoms

No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen. They often cause no symptoms. Where they occur, symptoms include

• irregular menstrual bleeding,
• bleeding between menstrual periods,
• excessively heavy menstrual bleeding (menorrhagia), and
• vaginal bleeding after menopause.

Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause. If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.

Risk factors and epidemiology

Endometrial polyps usually occur in women in their 40s and 50s. Risk factors include

• obesity
• high blood pressure
• history of cervical polyps.
• taking tamoxifen or hormone replacement therapy
• are present in 25% of women with abnormal vaginal bleeding.

Diagnosis

Endometrial polyps can be detected by

• vaginal ultrasound, especially 3D ultrasound
• sonohysterography
• hysteroscopy
• accidentally by dilation and curettage

Treatment

Polyps should be surgically removed using hysterescopy. When curettage is performed, polyps may be missed. During hysterescopy, the polyp can be visualized and removed through the cervix. If it is a large polyp, it can be cut into sections before each section is removed, this is called Operative Hysteroscopy. If cancerous cells are discovered, a hysterectomy may be performed. A hysterectomy would usually not be considered if cancer has been ruled out.

Prognosis and complications

Endometrial polyps are usually benign although some may be precancerous or cancerous. About 0.5% of endometrial polyps contain adenocarcinoma cells. Polyps can increase the risk of miscarriage in women undergoing IVF treatment. If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant. Although treatments such as hysterescopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.