| Endometrial polyp | |
|---|---|
| Other names | Uterine polyp |
 | |
| Endometrial polyp, viewed by sonography | |
| Specialty | Gynecology |
Anendometrial polyp oruterine polyp is amass in the inner lining of the uterus.[1] They may have a large flat base (sessile) or be attached to the uterus by an elongatedpedicle (pedunculated).[2][3] Pedunculated polyps are more common than sessile ones.[4] They range in size from a few millimeters to several centimeters.[3] If pedunculated, they can protrude through thecervix into thevagina.[2][5] Small blood vessels may be present, particularly in large polyps.[2]
They often cause no symptoms.[4] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding aftermenopause.[3][6] Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.[7] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.[5]
No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulatingestrogen.[3] Risk factors includeobesity,high blood pressure and a history ofcervical polyps.[3] Takingtamoxifen orhormone replacement therapy can also increase the risk of uterine polyps.[3][8] The use of anintrauterine system containinglevonorgestrel in women taking tamoxifen may reduce the incidence of polyps.[9]
Endometrial polyps can be detected byvaginalultrasound (sonohysterography),hysteroscopy anddilation and curettage.[3] Detection by ultrasonography can be difficult, particularly when there isendometrial hyperplasia (excessive thickening of the endometrium).[2] Larger polyps may be missed by curettage.[10]
Endometrial polyps can be solitary or occur with others.[11] They are round or oval and measure between a few millimeters and several centimeters in diameter.[7][11] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.[7] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrialepithelium.[7] If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall.[11] Pedunculated polyps are more common than sessile ones.[4]
Polyps can be surgically removed usingcurettage with or without hysteroscopy.[12] When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using graspingforceps at the beginning of the curettage procedure.[7] Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through thecervix. Large polyps can be cut into sections before each section is removed.[7] The presence ofcancerous cells may suggest ahysterectomy (surgical removal of the uterus).[3] A hysterectomy is usually not considered when cancer is not present.[7] In either procedure,general anesthetic is typically supplied.[10]
The effects of polyp removal on fertility has not been studied.[13]
Endometrial polyps are usuallybenign although some may beprecancerous orcancerous.[3] About 0.5% of endometrial polyps containadenocarcinoma cells.[14] Polyps can increase the risk ofmiscarriage in women undergoingIVF treatment.[3] If they develop near thefallopian tubes, they may lead to difficulty in becoming pregnant.[3] Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.[7] Untreated, small polyps may regress on their own.[15]
Endometrial polyps usually occur in women in their 40s and 50s.[3] Endometrial polyps occur in up to 10% of women.[2] It is estimated that they are present in 25% of women with abnormal vaginal bleeding.[8]
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