Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. They result from an overgrowth of cells in the lining of the uterus (endometrium). Uterine polyps are usually noncancerous (benign), although some can eventually turn into cancer (precancerous polyps). They are usually not-sensitive to cyclical hormonal changes.
Polyps may be soft and cystic or firm and fibrous; they may be pedunculated or sessile, single or multiple, and vary in size from small – with minimal uterine cavity distortion – to large, filling the whole uterine cavity.1
Signs and symptoms of uterine polyps include:
A diagnosis of polyp is often suggested by a transvaginal ultrasound but the confirmation of the diagnosis can only been made by hysteroscopy.
Hysteroscopy also allows biopsies to be taken in order to confirm the benign or malignant nature of the polyp. Occasionally other diagnostic techniques such as a hystosalpingography (x-ray of uterus is taken after filling it with a dye) and saline sonography (ultrasound scan is done after filling the uterine cavity with normal saline) may detect uterine polyps.
Certain hormonal medications with an anti-estrogenic effect, including progestins and gonadotropinreleasing hormone agonists, may lessen symptoms of the polyp.
Blind methods to retrieve focal intrauterine pathology included blind curettage of the endometrium or avulsion with polyp forceps. These approaches can be associated with potential uterine trauma, which can be unrecognised and lead to serious complications. Failure to remove polyps and problems with incomplete removal are also well recognised. Removal of uterine polyps should therefore be peformed with visual control (hysteroscopy).
Advances in hysteroscopic technology have enabled small polyps to be removed under direct vision. Fine mechanical instruments, such a scissors or biopsy forceps can be used down a 2 to 3 mm diameter working channel of a rigid operative hysteroscope The safety and feasibility of such approaches have been reported.3
Larger polyps are often removed using a large-diameter electrosurgical hysteroscopic resection under anaesthesia. Recent technologies have been developed to allow non electrical mechanical removal of polyps in the outpatient setting. The latter technique may be performed without or with limited local anaesthesia.4,5
1. http://www.cancerresearchuk.org/about-cancer/womb-cancer/survival?_ga=2.108996610.1240754579.1518112268-1711705109.1518112268 And Clark TJ, Middleton LJ, Cooper NAM, et al. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technology Assessment, No. 19.61. NIHR Journals Library; 2015 Jul.
2. https://medium.com/clued-in/uterine-polyps-a-common-reason-for-irregular-bleeding-around-menopause-2b6b187be275 ;
4. https://www.mayoclinic.org/diseases-conditions/uterine-polyps/symptoms-causes/syc-20378709 And Clark TJ, Middleton LJ, Cooper NAM, et al. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technology Assessment, No. 19.61. NIHR Journals Library; 2015 Jul.
5. https://www.mayoclinic.org/diseases-conditions/uterine-polyps/diagnosis-treatment/drc-20378713 ; https://www.womenshealth-concern.org/help-and-advice/factsheets/uterine-polyps/