Endometrial Polyps

Endometrial polyps are small, soft growths on the lining of the uterus (the endometrium). Also known as
uterine polyps, endometrial polyps can irritate the surrounding tissue and cause spotting or vaginal
bleeding. The polyps can occur alone or in groups. Most uterine polyps are noncancerous (benign).
What causes endometrial polyps?
While the exact cause of endometrial polyps isn't known, they form when there is an overgrowth of
tissue in the lining of the uterus.
What are the symptoms of endometrial polyps?
Endometrial polyps often cause no symptoms. If signs or symptoms do occur, they may include:

Irregular menstrual bleeding

Bleeding between menstrual periods

Excessively heavy menstrual periods

Vaginal bleeding after menopause

Infertility
What are the risk factors for endometrial polyps?
Factors that may increase your risk of developing endometrial polyps include:

Obesity

Use of tamoxifen, a drug therapy for breast cancer

High blood pressure (hypertension)

Cervical polyps
How are endometrial polyps diagnosed?
Tests that may be run to determine the presence of polyps include:

Pelvic exam (in some cases endometrial polyps may be seen if they are protruding through the
cervix)

Pap smear

Ultrasound

Hysterosalpingogram (HSG). Uses an x-ray and contrast dye injected into the uterus to detect
polyps.

Dilatation and curettage (D&C). Scraping the walls of the uterus to obtain a tissue sample.

Hysteroscopy. Minimally invasive approach that uses a tiny telescope (hysteroscope) to examine

the uterine lining for polyps.

How are endometrial polyps treated?
Treatment options for endometrial polyps include:
Watch and wait approach. If the polyps are small and not causing symptoms, they may be left alone
and watched to see if they go away on their own.

Medication. Certain medications may shrink the polyps and lessen symptoms, however the symptoms
typically recur once the medication is stopped.
Surgical removal. Endometrial polyps can be removed during hysteroscopy, a procedure that uses a
tiny telescope (hysteroscope) and thin surgical instruments to view and treat areas inside the uterus. A
curettage may also be performed - scraping of the uterus to remove the polyps - guided by a
hysteroscope.
Hysterectomy. In rare cases a hysterectomy (surgery to remove the uterus) may be recommended to
remove cancerous cells or numerous polyps. Uterine polyps can recur, requiring additional treatment.
endometrial polyp or uterine polyp is a mass in the inner lining of the uterus.[1] They may have a large
flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).[1][2] Pedunculated
polyps are more common than sessile ones.[3] They range in size from a few millimeters to several
centimeters.[2] If pedunculated, they can protrude through the cervix into the vagina.[1][4] Small blood
vessels may be present, particularly in large polyps. [1]
Contents
[hide]

1 Cause and symptoms

2 Diagnosis

3 Treatment

4 Prognosis and complications

5 Risk factors and epidemiology

6 Structure

7 See also

8 References

Cause and symptoms[edit]

No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels
and grow in response to circulating estrogen.[2] They often cause no symptoms.[3] Where they occur,
symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively
heavy menstrual bleeding (menorrhagia), and vaginal bleeding aftermenopause.[2][5] 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.[6] If the polyp protrudes through the cervix
into the vagina, pain (dysmenorrhea) may result.[4]

Diagnosis[edit]

Micrograph of an endometrial polyp. H&E stain.

Endometrial polyps can be detected

byvaginal ultrasound(sonohysterography), hysteroscopy and dilation and curettage.[2] Detection by
ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive
thickening of the endometrium).[1] Larger polyps may be missed by curettage.[7]

Treatment[edit]
Polyps can be surgically removed using curettage with or without hysteroscopy.[8] When curettage is
performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first
explored using graspingforceps at the beginning of the curettage procedure.[6]Hysteroscopy involves
visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through
the cervix. If it is a large polyp, it can be cut into sections before each section is removed.
[6]

Ifcancerous cells are discovered, a hysterectomy(surgical removal of the uterus) may be performed.

[2]

A hysterectomy would usually not be considered if cancer has been ruled out. [6] Whichever method is

used, polyps are usually treated under general anesthetic.[7]

It is unclear if removing polyps affects fertility as it has not been studied. [9]

Prognosis and complications[edit]

Endometrial polyps are usually benign although some may be precancerous or cancerous.[2] About
0.5% of endometrial polyps contain adenocarcinoma cells.[10]Polyps can increase the risk
of miscarriage in women undergoing IVF treatment.[2] If they develop near thefallopian tubes, they may
lead to difficulty in becoming pregnant.[2] Although treatments such as hysteroscopy usually cure the
polyp concerned, recurrence of endometrial polyps is frequent. [6] Untreated, small polyps may regress
on their own.[11]

Risk factors and epidemiology[edit]

Endometrial polyps usually occur in women in their 40s and 50s. [2] Risk factors include obesity, high
blood pressure and a history of cervical polyps.[2] Takingtamoxifen or hormone replacement therapy can
also increase the risk of uterine polyps.[2][12] The use of anIntraUterine
System containing levonorgestrel in women taking Tamoxifen may reduce the incidence of polyps.
[13]

Endometrial polyps occur in up to 10% of women.[1] It is estimated that they are present in 25% of

women with abnormal vaginal bleeding.[12]

Structure[edit]
Endometrial polyps can be solitary or occur with others.[14] They are round or oval and measure between
a few millimeters and several centimeters in diameter.[6][14] They are usually the same red/brown color of
the surrounding endometrium although large ones can appear to be a darker red. [6] The polyps consist
of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrialepithelium.
[6]

If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are

connected by a flat base to the uterine wall.[14]Pedunculated polyps are more common than sessile
ones.[3]