Polyps

What are Uterine Polyps?

Uterine polyps, also known as endometrial polyps, are growths attached to the inner wall of the uterus that extend into the uterine cavity. They are formed by the overgrowth of cells in the endometrium (the uterus lining). Uterine polyps are usually benign (noncancerous), but they can sometimes become precancerous or cancerous, particularly in postmenopausal women. The size of uterine polyps can vary from a few millimetres to several centimetres, and there can be one or multiple polyps.

Impact of Uterine Polyps on Anatomy and Health

Uterine polyps are most commonly benign but, in some cases, can cause abnormal bleeding. Although they are infrequently cancerous, having them checked out by a healthcare professional to rule out other causes or conditions is important. 

They are often discovered incidentally during a pelvic ultrasound or an evaluation for abnormal vaginal bleeding.

Risk Factors for Uterine Polyps

Uterine polyps can affect women of any age, but they are more common in women between 40 and 60. They occur more frequently in women who have been through menopause and are most likely due to the hormonal changes that occur during menopause. They are also commonly found in women with a higher oestrogen level. Some other risk factors that can increase the likelihood of developing polyps include:

• Obesity
• Taking hormonal therapy (HRT) or oral contraceptive  pills for an extended period
• Infertility
• Endometriosis
• Family history of polyps or uterine cancer
• Chronic Inflammation or pelvic infections
• Anovulatory cycles (cycles without ovulation), such as in women with Polycystic ovarian syndrome

Causes of Uterine Polyps

Uterine Polyps may occur spontaneously or because of high levels of oestrogen hormone, although it is unknown what causes them. Polyps grow faster during pregnancy and with the use of oral contraceptives or oestrogen replacement therapy.

Although most polyps are noncancerous, the polyps that develop in women during or after menopause have an increased risk of becoming cancerous.

Symptoms of Uterine Polyps

Not all women with uterine polyps will have symptoms, but some common symptoms include the following:

• Abnormal Vaginal Bleeding: This can be heavy, prolonged or irregular menstrual periods or bleeding between periods or after menopause.
• Vaginal discharge: Some women with polyps may have an increased vaginal discharge or a change in the odour or colour of the discharge.
• Pelvic pressure or pain: Uterine polyps will infrequently cause pelvic pressure or pain.
• Infertility: Polyps may make it difficult to get pregnant due to a negative impact on implantation and are associated with miscarriage

Reduce the Risk of Uterine Polyps

While it is not always possible to prevent uterine polyps entirely, there are several strategies to reduce the risk and ensure early detection:

Lifestyle Modifications

• Maintain a Healthy Weight:
• Balanced Diet: Eat a diet rich in fruits, vegetables, whole grains, and lean proteins. High-fibre foods can help regulate oestrogen levels.
• Regular Exercise: Engage in regular physical activity to help maintain a healthy weight and balance hormone levels.
• Avoid Hormonal Imbalances:
• Hormone Therapy: If undergoing hormone replacement therapy (HRT) or taking medications that affect hormone levels (like tamoxifen), discuss the risks and benefits with your doctor. Use the lowest effective dose for the shortest duration necessary.

Regular Medical Check-Ups

• Routine Gynaecological Exams:
• Annual Exams: Regular visits to your gynaecologist for pelvic exams and Pap smears can help detect abnormalities in the reproductive system early.
• Ultrasound Screenings: If you have a higher risk due to family history or previous polyps, your doctor may recommend regular transvaginal ultrasounds to monitor the uterine lining.

Manage Underlying Health Conditions

• Control Chronic Conditions:
• Diabetes Management: If you have diabetes, keep blood sugar levels under control, as this can affect hormonal balance.
• Hypertension Control: Manage high blood pressure through diet, exercise, and medications.

Hormonal Balance

• Hormonal Contraceptives:
• Birth Control Pills: In some cases, birth control pills or other hormonal contraceptives may help regulate menstrual cycles and reduce the risk of developing polyps.

Types of Uterine Polyps

Based on Their Attachment

• Sessile Polyps have a broad base and are flat against the uterine lining.
• Pedunculated Polyps are attached to the uterine wall by a thin stalk.

Based on Histology (Cellular Structure)

• Benign Polyps are noncancerous and do not pose a significant risk of becoming cancerous.
• Precancerous Polyps have the potential to develop into cancer over time.
• Cancerous Polyps have already developed into endometrial cancer.

Diagnosis of Uterine Polyps

Polyps are typically diagnosed during a pelvic examination or ultrasound. The following diagnostic tools can be used to confirm the presence of polyps:

• Pelvic Exam: During a pelvic examination, your doctor will use a speculum to visualise the cervix and may feel for any abnormalities in the uterus.
• Ultrasound: Transvaginal ultrasound, which uses sound waves to create images of the uterus and ovaries, can detect polyps and evaluate their size, shape and location.
• Hysteroscopy: During this procedure, a thin, lighted scope is inserted through the cervix into the uterus, allowing the healthcare professional to see inside the uterus and visualise any polyps. This is most commonly performed under an anaesthetic. 
• Biopsy: A small sample of tissue may be taken from the polyp for examination under a microscope. This can confirm the diagnosis and rule out abnormal cell growth or cancerous change.

Treatments for Uterine Polyps

The treatment of uterine polyps will depend on the size, location, and symptoms caused by the polyps. Some common treatment options include:

• Watchful Waiting: Smaller polyps that do not cause problems need not be removed. Polyps should be assessed intermittently to check their progression.
• Medications: For some women, hormonal medications such as oral contraceptives may shrink the polyp's size or control abnormal bleeding caused by the polyps.
• Hysteroscopic Polypectomy: In this procedure, the polyps are removed using a hysteroscope, a thin, lighted instrument inserted through the cervix into the uterus while the woman is under sedation. This procedure is performed most commonly under an anaesthetic as a day surgery procedure.
• Surgery: If polyps are large or are found to be precancerous or cancerous, surgery to remove the uterus (hysterectomy) might be recommended.

In some cases, a combination of treatments might be necessary.  After the polyps are removed, regular follow-up may be required to monitor for recurrence or other potential complications.

Recovery time will vary depending on the type of procedure. Most women can return to normal activities following hysteroscopic polypectomy within a few days or up to 2 weeks. It's important to follow the post-operative instructions provided by your doctor to ensure a smooth and comfortable recovery.

It's also worth mentioning that some women may experience cramping or bleeding after the procedure. However, this is usually mild and should be discussed with your doctor if it's causing significant discomfort.

What if Uterine Polyps are Untreated?

Leaving uterine polyps untreated can lead to several potential complications:

Persistent Symptoms

• Irregular Menstrual Bleeding: Untreated polyps can continue to cause heavy or prolonged menstrual periods, bleeding between periods, and postmenopausal bleeding, which can be disruptive and uncomfortable.
• Anaemia: Chronic heavy menstrual bleeding can lead to iron deficiency anaemia, causing fatigue, weakness, and other health issues.

Infertility and Pregnancy Complications

• Infertility: Polyps can interfere with the implantation of an embryo, making it difficult to conceive. They can also increase the risk of miscarriage and complications during pregnancy.
• Miscarriage: If polyps are present during pregnancy, they can increase the risk of miscarriage and other pregnancy-related complications.

Cancer Risk

• Precancerous Changes: Some polyps can potentially become precancerous (atypical hyperplasia). If left untreated, these changes can progress to endometrial cancer.
• Cancer Development: Although rare, untreated polyps can become malignant over time, leading to endometrial cancer. Early detection and removal of polyps can significantly reduce this risk.

Overall Health Impact

• Chronic Discomfort: Persistent symptoms and complications can affect overall quality of life and well-being.
• Increased Medical Costs: Delayed treatment can lead to more severe health issues, requiring more extensive and costly medical interventions.