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Uterine Polyps

Obstetrics and GynaecologyReproductive Medicine Gynaecological Oncology

Uterine Polyps refer to benign tumours formed by the overgrowth of mucosal cells in the uterine cavity. It can be further classified as an endometrial and cervical polyp based on its growth location. Uterine polyps may cause mild bleeding or discomfort and are typically discovered during routine gynaecological examinations in women.

Symptoms

Uterine Polyps may cause the following symptoms:

Non-menstrual vaginal bleeding: Uterine polyps can lead to vaginal bleeding outside of the menstrual cycle.
Excessive menstrual bleeding or prolonged periods: When uterine polyps affect the normal blood flow in the endometrium, it may result in excessive menstrual bleeding or long menstrual periods.
Uterine cramps or pain: In some cases, uterine polyps may cause uterine cramps or a pain sensation.
Pain during sexual intercourse: Uterine polyps may cause discomfort or pain during sexual intercourse.
Abdominal discomfort: Some women may feel abdominal discomfort or lower abdominal pain.

Factors

Uterine polyps can occur at any age, but they are more common in women aged 40-50. Women who have had Polycystic Ovary Syndrome (PCOS) or endometrial inflammation have a 0.5-4.8% chance of developing uterine polyps. The size and number of uterine polyps vary from person to person, ranging from one to multiple, with sizes ranging from 0.5 cm to several cm.

Diagnosis

Pelvic Examination	Doctor can perform a pelvic examination to inspect the endometrium and cervix, checking for polyps.
Pap Smear	In many cases, uterine polyps are discovered during a Pap smear.
Uterine Ultrasound	Through ultrasound examination, abnormal uterine masses can be visualized, confirming the presence of polyps and determining their size and location.
Biopsy or Endometrial Biopsy	If polyps are detected during an ultrasound or other examinations, the doctor may recommend a tissue biopsy to determine whether they are malignant tumours. In cases where uterine polyps are suspected, a doctor may perform an endometrial biopsy to obtain tissue from the inner lining of the uterus.

Treatments

Observation	For asymptomatic small endometrial polyps, particularly in premenopausal women, doctors may recommend regular monitoring and a wait-and-see approach, as these polyps can sometimes resolve on their own or may not cause any issues. Patients must undergo regular ultrasound exams to monitor if the polyps enlarge or start causing symptoms.
Medication	For patients with mild symptoms or irregular menstruation, doctors may recommend hormonal therapy, such as oral contraceptives or progestins, to control symptoms and prevent the polyps from enlarging.
Surgical Removal	Traditional Surgery: Involves general anaesthesia and electrocautery. The surgery typically takes longer, and there is a chance of damaging the muscle layer or other organs during the procedure, resulting in more pain for the patient and requiring post-surgical hospitalization for observation. Minimally Invasive Surgery: Involves using a hysteroscope for a non-invasive procedure. The hysteroscope is inserted through the vagina into the uterus, where a cold knife is used to remove fibroids and polyps. This method is safer, and the procedure can generally be completed in about 15 minutes.
Hysterectomy	For patients with multiple endometrial polyps, persistent symptoms, or suspected malignancy, especially in postmenopausal women, a hysterectomy may be considered. A hysterectomy is a more radical treatment option. It is only recommended for patients with recurring polyps or a high risk of malignancy, as it can completely resolve the issue after surgery.

FAQ

Some studies suggest that endometrial polyps may be associated with infertility or difficulty conceiving, but not all uterine polyps will necessarily lead to infertility. Potential influencing factors may include their impact on the shape and structure of the uterine cavity, affecting the fertilised egg's implantation and the embryo's development. During pregnancy, uterine polyps may increase the risk of miscarriage or preterm birth. The development of uterine polyps may also be related to hormone levels, and hormonal abnormalities could potentially have adverse effects on pregnancy.

Most uterine polyps are benign; however, in sporadic cases, uterine polyps may become malignant (cancerous), especially in postmenopausal women. Suppose a patient experiences symptoms such as uterine bleeding, abnormal vaginal bleeding, or irregular menstruation. In that case, doctor may recommend further examinations, including a biopsy, to confirm the presence of cancerous changes.