Endometrial (Uterine) Polyps: Causes, Symptoms, and Treatments

What is an endometrial or uterine polyp?

Endometrial polyps, also known as uterine polyps, refer to the excessive growth of endometrial tissue, specifically endometrial glands and stroma, within the endometrial cavity.

Polyps can grow in the endometrial cavity as a single lesion or multiple lesions. These lesions are usually non-cancerous (benign) but in some cases, they may turn into cancerous polyps (precancerous) or cancer. 

What causes endometrial polyps?

Endometrial polyps are known to be related to the stimulation of the female hormone oestrogen. Long-term exposure to oestrogen can increase the risk of developing endometrial polyps. 

What are the signs and symptoms of endometrial polyps?

Endometrial polyps may present with several symptoms, including:

1) Vaginal Bleeding

The most common symptom of endometrial polyps is vaginal bleeding, which can present as:

• Bleeding after menopause
• Excessive bleeding during periods or prolonged periods.
• Vaginal bleeding or spotting in between periods. 

2) Infertility

In some women, endometrial polyps may cause difficulties in getting pregnant. If you experience any of these symptoms, it is important that you consult a gynaecologist or fertilty specialist for a proper diagnosis and treatment.

How are endometrial polyps treated?

Treatment depends on your symptoms and other factors that may increase the risk of endometrial cancer. It is important for you to consult your doctor for the best possible treatment option. In general, treatments include::

1) Medical

• Hormonal medications are used to keep the hormones balanced and relieve the symptoms. 

2) Surgical

• Polypectomy

  • A procedure to remove the polyps.

• Hysterectomy

  • Removal of the whole uterus in cases where the polyps are cancerous. 

What are the risk factors for developing endometrial polyps?

There are several factors that increase the risk of developing endometrial polyps. Some of them include:

• Age 

  • It is most common in women of ages between 40s and 50s (perimenopausal women) followed by after 50s (postmenopausal women)

• Weight

  • Overweight (BMI 25 - 29.9) and obese (BMI > 30) women are at higher risk

• High blood pressure

  • Women with hypertension

• Cancer medication

  • Tamoxifen, a medication used to treat breast cancer can increase the risk of developing polyps

• Hormonal therapy

  • High doses of oestrogen in hormonal replacement therapy for menopause

How are endometrial polyps diagnosed?

A diagnosis of an endometrial polyp can be made by assessing detailed symptoms and conducting specific medical examinations. Your doctor will begin by reviewing your personal and family medical history, along with any other relevant information. They will then perform a pelvic exam and a Pap smear.

Additional investigations may be conducted to confirm the diagnosis. These investigations may include:

1. Transvaginal ultrasonography

   • Your doctor inserts a handheld device called an ultrasound transducer into your vagina to view the image of your inner uterus.

2. Sonohysterography

   • After the initial transvaginal ultrasound, your doctor will inject some sterile fluid into your uterus through a catheter. The fluid causes the uterus to expand to provide a clearer image of any growth or irregularity in the uterus.  

3. Hysteroscopy

   • Your doctor inserts a long, thin tube with a lighted telescope (hysteroscope) through the vagina and cervix to examine inside the uterus. 

4. Endometrial biopsy

   • Your doctor inserts a thin soft plastic instrument to collect some tissues from the inner wall of your uterus. The tissues will then be sent to the laboratory to detect any abnormal cells. 

5. Curettage

   • Your doctor inserts a long metal instrument called curette to scrape the tissues or polyps from the inner wall of your uterus. The tissues or polyps will then be sent to the laboratory to detect any abnormal cells. 

FAQ

Will my endometrial polyp turn into cancer?

Only about 5% of endometrial polyps are cancerous. You may have a greater risk of getting cancerous endometrial polyp if you are at the postmenopausal age. 

Can I prevent myself from getting an endometrial polyp?

Currently, there is no known method to prevent endometrial polyps. However, raising awareness and ensuring early diagnosis are crucial.

Should I worry about endometrial polyps?

Take comfort in knowing that only a small percentage of endometrial polyps will turn cancerous. If you are in a group that is at high risk of developing endometrial cancer, you are advised to talk to your healthcare provider.

When should I seek medical attention? 

Make an appointment with your healthcare provider if you experience the following:

• Vaginal bleeding or spotting after menopause 
• Vaginal bleeding or spotting if you are not on your period 
• Vaginal bleeding that is heavier or longer than usual

Sometimes abnormal bleeding can be a sign of endometrial polyps, particularly if you are postmenopausal. For an early and accurate diagnosis, it is best to consult with your doctor.