Endometrial Polyp

What is an endometrial polyp?

Endometrial polyps are growths or masses that occur in the lining of the inner wall of the uterus and often grow large enough to extend into the uterine cavity. They attach to the uterine wall by a large base (these are called sessile polyps) or a thin stalk (these are called pedunculated polyps).

Endometrial polyps can be asymptomatic or can present with abnormal vaginal bleeding. This is characterized as lighter or heavier than your normal flow, bleeding when you are not expecting your menstrual period, or during a time when you are not expecting your period, such as before puberty, during pregnancy, or after menopause.

Treatment involves careful monitoring, as polyps can sometimes be malignant and lead to cancer or problems with fertility. Removal may be necessary as well as medication.

You should speak with your primary care physician or OB/GYN about these symptoms.

Symptoms of endometrial polyps

Endometrial polyps can be asymptomatic (meaning they do not present with any symptoms); however, most of the time they present with abnormal vaginal bleeding. In order to better distinguish between the two, characteristics of normal bleeding has also been outlined.

Characteristics of normal vaginal bleeding

The definition of a "normal menstrual cycle" is different for every woman. A menstrual cycle for one woman may last for a few days but for another woman may last a week or more. Other characteristics include:

• Occurring every 21 to 35 days
• Healthy shedding of the uterine lining
• Signal of a new reproductive cycle

Characteristics of abnormal vaginal bleeding

Vaginal bleeding unrelated to a normal menstrual cycle is considered abnormal. Be suspicious of endometrial polyps if your vaginal bleeding is different from your regular pattern. For example, abnormal patterns of vaginal bleeding include bleeding that is:

• Lighter or heavier than normal
• At an unexpected time
• At an unexpected phase of life: This is if bleeding occurs a time in your life when it is not expected such as before puberty, during pregnancy, or after menopause (which is defined as 12 or more consecutive months without a menstrual period).

Complications

Complications caused by endometrial polyps may include:

• Infertility: Endometrial polyps may cause you to be unable to get pregnant and have children. The mechanism for this is unknown but sometimes removal of the polyps may allow you to become pregnant.
• Cancer: Approximately 5 percent of endometrial polyps are malignant. However, data shows that the incidence of polyps that were malignant was significantly higher in postmenopausal compared with premenopausal women, and higher in women who had symptoms of bleeding than in women who did not.

Causes of endometrial polyps

Polyps are caused by overgrowth of the cells lining the uterus (also known as endometrial cells). These cells are very sensitive to the hormone estrogen and grow as a response to circulating levels of estrogen. Endometrial polyps are relatively common in women who [5]:

• Are menopausal or postmenopausal
• Are adolescents: Although this is less common
• Are obese (BMI 30)
• Have Lynch syndrome: Women who have Lynch syndrome increased incidences of endometrial polyps compared to the general population, and also have an increased risk of endometrial cancer.
• Use Tamoxifen: This is a drug therapy for breast cancer that places women at a higher risk for developing endometrial polyps and sometimes cancer.

Size, location, and diagnosis

Endometrial polyps can range in size from millimeters (about the size of a sesame seed) to centimeters (about the size of a golf ball and even larger). They also range in number women can have one or many endometrial polyps. These polyps usually stay within the uterus but can sometimes grow into the cervix (opening of the uterus) and protrude into the vagina.

These endometrial polyps can often look like tumors but are usually, but not always, noncancerous (benign). However, sometimes these polyps can become cancerous, and thus are known as precancerous polyps.

Treatment options and prevention for endometrial polyp

Treatment for endometrial polyps involves decreasing circulating levels of estrogen to help stop their growth or removal of the polyps altogether. Your physician may recommend the following watchful waiting, medication, or surgical removal.

• Watchful waiting: Small polyps that are asymptomatic might get better on their own. Treatment of these small polyps that you may not even know are there is unnecessary unless you have a greater risk of endometrial cancer.
• Medication: Certain hormonal medications, including progestins and gonadotropin-releasing hormone agonists, may lessen symptoms of the polyp. But taking such medications is usually a short-term solution at best symptoms typically recur once you stop taking the medicine.
• Surgical removal: During hysteroscopy, instruments inserted through the hysteroscope the device your physician uses to see inside your uterus make it possible to remove polyps. The removed polyp will likely be sent to a lab for microscopic examination.

When to seek further consultation for endometrial polyp

Seek immediate medical attention if:

• You have sudden, severe pain in your belly or pelvis area
• You are soaking through your usual pads or tampons every hour for two or more hours
• You feel dizzy or lightheaded, or you feel like you may faint