Also called as Endometrial Polyps, Uterine Polyps are small growths that are usually found attached to the inner uterine wall. These polyps are usually caused due to the excess growth of cells in the endometrial lining. In certain cases, the polyps would be very small (only a few millimeters in size) and flat in appearance (called as sessile uterine polyps).
In others, they may grow to the size of a golf ball (possibly larger) and would extend into the uterine cavity or vagina by means of an elongated stalk called a pedicle (called as pedunculated uterine polyps). Peduculated uterine polyps are more common than sessile polyps and usually contain one or more tiny blood vessels.
It is possible for a woman to have just one uterine polyp or multiple polyps. And while most polyps are benign and do not cause any harm to the body, some can be cancerous. In rare cases, some polyps can start off as benign and then turn cancerous with time. These are called precancerous polyps.
Common Causes and Risk Factors for the Formation of Uterine Polyps
The main cause for the formation of uterine polyps is not known. The most common cause for uterine polyps in women, however, is attributed to hormonal changes or hormonal imbalances. Like the endometrial lining of the uterus, uterine polyps are very sensitive to the presence of estrogen and usually grow in the presence of excess circulating estrogen in the body.
Since the general cause for the formation of uterine polyps is unclear, it is not known whether the condition would occur in all women or restrict itself to certain women with specific constraints. However, the condition has a few risk factors that would put women more at risk of developing uterine polyps.
Some of the risk factors associated with uterine polyps include age (usually over 40 years of age), menopause (pre or postmenopausal periods), obesity, high body mass index and hormonal medications (like Novaldex or Tamoxifen which are anti estrogen drugs).
Symptoms and Complications associated with Uterine Polyps
Since most uterine polyps are benign, it would be hard to notice their presence inside the uterus. In certain cases, the polyps may not cause any symptoms at all (called asymptomatic uterine polyps).
Certain uterine polyps can cause symptoms like excessive menstrual bleeding, irregular menstrual bleeding, spotting (or) bleeding in between menstrual cycles and post menopausal vaginal bleeding etc. In the worst case scenario, uterine polyps can cause fertility issues in women. You may want to check with a doctor if you seem to experience any or all of these symptoms.
Complications arising from Uterine Polyps
Although uterine polyps are not considered dangerous (unless they are cancerous) they may cause fertility issues in certain women. Multiple uterine polyps have been known to cause infertility in females. In certain cases, the presence of multiple polyps in the uterus can increase the chances of miscarriage. It can also hinder the progress of procedures like in vitro fertilization (IVF). If so, then the polyps would have to be removed first before starting treatment for the other conditions mentioned above.
Diagnosing a Uterine Polyp
The presence of uterine polyps can be confirmed by any one of the following methods.
In this method, a wand like device is inserted into the uterus via the vagina. The tip of the wand would create and disperse high frequency sound waves throughout the uterus. The sound waves would bounce off the walls of the uterus and form an image of the inner uterus (and the polyps) on a computer screen.
A Sonohysterogram would involve using a narrow catheter to fill up the uterine cavity with saline. The saline would tend to expand the uterine cavity like a balloon, stretching the uterine walls for more exposure. A space would also be created between the uterine walls. This in turn would aid the doctor in spotting hidden polyps that are usually not visible in an ultrasound.
This method for diagnosing polyps involves injecting a substance containing faint traces of a contrast dye into the uterus. An X –Ray would then be taken to examine the polyps, uterine wall and fallopian tube, all of which would stand out significantly due to the dye.
This method to diagnose uterine polyps would involve inserting a scope like device into the uterus via the vagina.
The scope (or) tube would contain a tiny camera at the tip which would relay back images of the uterus and the presence of polyps if any. The images would clearly show details like the number of polyps in the uterus and their sizes. In certain cases, a device would be inserted into the hysteroscopic tube and would be used to cut all or a portion of the polyp for microscopic evaluation.
The curettage is a long metal instrument that is inserted into the uterus through the vagina to get a sample of the polyp for microscopic evaluation. The device contains a loop at the end which would help the doctor scrape the inner uterine wall for small or large specimens. These specimens would then be sent to the lab for evaluation. In most cases, the curettage is used along with a hysteroscope that views the inner walls of the uterus first.
A surgical biopsy or excision can also be done to retrieve samples of the polyps. In this case, a long straw like instrument is inserted into the uterus via the vagina for samples. The retrieved samples are then sent to the lab for testing. A thorough examination of the polyp would enable the doctor to diagnose it and find out whether it is malignant or benign.
Treatment Options of Uterine Polyps
In most cases, uterine polyps tend to disappear on their own. However, if they persist or cause the symptoms mentioned above, the doctor would recommend one or more of the treatment options mentioned below.
In case your doctor finds out that the polyp is small, benign or asymptomatic, he/she would recommend you to wait for a while to see if the polyp disappears on its own. He/she would recommend frequent checkups and tests to determine if the polyp is idle, shrinking or growing in size.
If the polyp appears to cause one or more of the symptoms mentioned above, your doctor would start you on certain hormonal medications to shrink it. Accordingly, medications like progestins and gonadotropin inducers are common choices for the treatment of uterine polyps.
However, the complete effect of these medications is not known and there are chances for the symptoms to recur once the medications are stopped. Hence, your doctor would only recommend these medications on a short term basis and monitor the effect they have on the polyps before deciding to continue them.
Removal by Curettage
The curettage can also be used to remove uterine polyps in addition to taking diagnostic samples. In this case, your doctor would insert the curettage into the uterus via the vagina and use the loop at the end to scrape off the polyps attached to the inner uterine wall. The procedure is usually carried out with the help of a viewing instrument called the hysteroscope.
Removal by Surgical Means
If multiple polyps are detected inside the uterus, your doctor may recommend surgical excision to remove them. This procedure is also carried out with the help of a surgical instrument that is inserted into the uterus through the hysteroscope tube. Surgical excision would also be considered as the best option if the polyps appear cancerous in nature.
In severe cases where the uterus contains multiple cancerous polyps, your doctor may recommend a hysterectomy to remove the entire uterus in order to prevent the condition from spreading to other parts of the body. This procedure is usually opted for when all other forms of treatment fail.
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