Endometrial polyps are a common but often misunderstood gynaecological condition. They can occur in women of all ages, but they are more prevalent in those approaching menopause. While many women may have endometrial polyps without experiencing any symptoms, others may suffer from abnormal bleeding, infertility, or even an increased risk of malignancy. This article provides an in-depth look at the causes, symptoms, diagnosis, and management of endometrial polyps.
Endometrial Polyps?
Endometrial polyps are growths that develop on the lining of the uterus, known as the endometrium. These polyps can vary in size and may be solitary or multiple. While they are usually noncancerous (benign), they can sometimes cause symptoms such as irregular menstrual bleeding, prolonged periods, or spotting between periods. Endometrial polyps are typically diagnosed through ultrasound or hysteroscopy. They may require treatment if they cause significant symptoms or if there is concern about cancer.
Causes and Risk Factors
Several factors contribute to the development of endometrial polyps, including:
Hormonal Imbalance: Excess estrogen is a significant risk factor, as polyps are estrogen-sensitive growths.
Age: Women in their 40s and 50s, especially those approaching menopause, are at a higher risk.
Obesity: Increased body fat can increase estrogen levels, promoting polyp growth.
Hypertension: Studies suggest a link between high blood pressure and endometrial polyps.
Tamoxifen Use: Women taking this medication for breast cancer treatment have an increased likelihood of developing polyps.
Symptoms of Endometrial Polyps
Many women with endometrial polyps experience no symptoms. However, when symptoms do appear, they often include:
Abnormal uterine bleeding (spotting between periods, heavy menstrual flow, postmenopausal bleeding)
Infertility or difficulty conceiving
Pelvic pain (in rare cases)
Diagnosis of Endometrial Polyps
Suppose a woman experiences abnormal bleeding or fertility issues. In that case, a gynaecologist may perform several diagnostic tests to identify the presence of polyps:
Transvaginal Ultrasound (TVUS): The first-line imaging technique that can reveal thickened endometrial tissue suggestive of polyps.
Saline Infusion Sonohysterography (SIS): A more detailed ultrasound that provides clearer images by using saline to expand the uterine cavity.
Hysteroscopy: A minimally invasive procedure in which a thin, lighted tube is inserted into the uterus to provide a direct view of the endometrial lining.
Endometrial Biopsy: In cases where malignancy is suspected, a sample of the endometrial tissue is taken for further analysis.
Treatment Options
The treatment of endometrial polyps depends on their size, symptoms, and whether they pose a risk of malignancy.
Expectant Management: Small, asymptomatic polyps in premenopausal women may resolve on their own and do not require immediate intervention.
Hysteroscopic Polypectomy: The gold-standard treatment involves the removal of polyps using a hysteroscope. This procedure is minimally invasive and has a low risk of complications.
Dilation and Curettage (D&C): Although once a standard procedure, D&C is now considered less effective than hysteroscopic removal and is generally not recommended.
Hormonal Therapy: Progestins or hormone-releasing intrauterine devices (IUDs) may help manage polyps in some cases, particularly for those with recurrent polyps.
Hysterectomy: In cases where polyps show signs of malignancy or when they recur frequently, surgical removal of the uterus may be recommended.
Endometrial Polyps and Fertility
There is ongoing debate about the impact of endometrial polyps on fertility. Some studies suggest that polyps interfere with embryo implantation, leading to reduced pregnancy rates. Hysteroscopic removal of polyps before assisted reproductive techniques (ART), like in-vitro fertilization (IVF), has been shown to improve pregnancy outcomes.
Malignancy Risk and Management
While most endometrial polyps are benign, postmenopausal women and those with risk factors such as obesity, diabetes, and hypertension should be monitored closely. If polyps exhibit atypical hyperplasia (pre-cancerous changes), a hysterectomy may be recommended to prevent the progression to endometrial cancer.
Conclusion
Endometrial polyps are common but often go undetected unless they cause symptoms like abnormal bleeding or infertility. Fortunately, they can be effectively diagnosed through ultrasound, hysteroscopy, and biopsy. Most cases can be managed with minimally invasive procedures like hysteroscopic polypectomy, ensuring relief from symptoms and reducing the risk of complications. If you suspect you may have endometrial polyps, consult your gynaecologist for proper evaluation and treatment.
By understanding endometrial polyps and seeking timely medical attention, women can effectively maintain their reproductive and overall health.