A uterine polyp, also known as endometrial polyp is an overgrowth of lining of the uterus. The concept is similar to that of a skin tag – basically normal tissue, but growing in an abnormal fashion. They are soft, fleshy growths that form on the inside of the uterus. Polyps remain attached to the uterus by a large base (sessile) or thin stalks (pedunculated).
Why does a polyp occur?
Uterine polyps arise from cells which form the endometrium, the inside lining of the uterus. During monthly cycle, the endometrial lining begins to grow, in preparation for implantation or attachment of an embryo. If no embryo is implanted i.e. if there is no pregnancy, this lining sheds in the form of periods. Sometimes however, due to hormonal imbalance or many a times unknown reasons, this endometrial lining grows too much, causing tiny clumps to form. These clumps are known as uterine polyps.
How common are they?
Between 10-25% of women develop polyps at some point of their lives. The risk for developing polyps increases as you grow older until menopause, with most women developing in their 30s and 40s. Polyps are rare in women under the age of 20 and above the age of 50.
How do I know whether I have a polyp?
Uterine polyps rarely cause symptoms. Some common symptoms are as follows:
Irregular menstrual bleeding
Spotting between periods
Bleeding after intercourse
Cramping in lower abdomen
Infertility or miscarriage
Different Locations of Uterine Polyps
How does a polyp affect fertility?
Many polyps are very small, a few millimeters in diameter, and do not cause any compromise in reproductive capabilities. However, larger polyps or multiple polyps can interfere with reproduction.
Uterine polyps as already mentioned affect the lining of the uterus.This lining is very important when it comes to embryo implantation. If the lining becomes unstable or unhealthy due to uterine polyps, it can interfere with implantation and also increase the risk of miscarriage. Few polyps can block the cervical canal or the area where fallopian tube connects to the uterine cavity which would prevent the sperm from entering the uterus or fallopian tube respectively.
Is there any risk of polyp being cancerous?
A polyp is considered a benign growth. However there is a small chance of them turning cancerous. Less than 1 % of polyps are associated with cancer. Examination of tissue under microscope is the only way to reliably determine whether the polyp is benign (non cancerous) or malignant (cancerous).
If they rarely cause symptoms, how are they diagnosed?
Most common non invasive way of diagnosis is ultrasound. It is easy to diagnose polyp between the 9th day and 15th day of the cycle. During rest of the menstrual cycle it is difficult to visualize and diagnose a polyp.
A polyp can also be diagnosed on a Hysterosalpingogram (HSG). HSG is an examination of uterus and fallopian tube using X-ray. A contrast dye is injected into uterus and fallopian tubes, to make it easier to visualize polyps.
A sonohysterogram is a special type of ultrasound in which the uterine cavity is filled with saline using a narrow catheter. The saline distends the cavity and creates a space between the walls. This aids in visualizing the polyps that may be missed with traditional ultrasound.
Hysteroscopy is a procedure using a small telescope inserted through the vagina and cervix into the uterus to view polyp and determine their size and extent. Removal of the polyp can be carried out in the same sitting.
Video of Hysteroscopic polyp
In olden days polyps were also diagnosed at the time of dilatation and curettage when an irregularity was felt in the uterine cavity while curetting. This is a blind technique and is no longer followed.
Is the removal of polyp necessary?
If a women has a uterine polyps and she’s experiencing infertility than removal of polyp/ polyps could boost her fertility. Also women who have to undergo in-vitro fertilization (IVF) treatment are generally advised to have uterine polyps removed before conducting embryo transfer procedure. About 80 % women get successfully pregnant in 12 months following removal of polyp. In women with polyps not related to fertility, large polyps causing symptoms or with suspicion of carcinoma have to be removed.
How are polyps removed?
Traditional methods to remove polyp include dilatation and curettage. However this is a blind procedure and does not guarantee removal of polyp.
Hysteroscopy can directly visualize the polyp; determine its location and size. Also removal can be carried out hysteroscopically under direct vision.
Video of hysteroscopic polyp resection
A pedunculated polyp can be removed by cutting the stalk directly; however larger and sessile polyps need removal in layers. The tissue is removed from the uterine cavity and sent for histopathology.
How many days do I need to rest after the procedure?
This procedure is a day care procedure, which means that you can go home in 6-8 hrs after surgery. No more than a day rest is needed and a couple of days leave from work is all that is required.
What type of anaesthesia is used?
Hysteroscopy is usually performed under a general anaesthesia, although sometimes local anaesthesia is used instead. Anaesthesia fitness will be done by an anaesthetist before the procedure.
What are the complications?
Hysteroscopy is considered safe however it carries some risks that a patient should be aware of.
Pelvic infection is not common but may manifest with lower abdominal pain, fever and offensive vaginal discharge and can be treated with antibiotics.
Hemorrhage and need for blood transfusion is very rarely necessary.
Although rare, the gas or fluid used to distend the uterine cavity could spill into your bloodstream and cause serious problems.
Occasionally there might be failure to visualize the uterine cavity if the neck of the womb is too tight.
Uterine perforation wherein scope or an instrument may pass through and through the uterine wall occurs in less than 1 % of cases.
Most of the time the injury may heal by itself and there are no furthur future complications. However there may be a need of prolongedhospital stay or sometimes further intervention. A laparoscopy (insertion of telescope through your umbilicus) may be performed to investigate any possible internal injury. Very rarely, a laparotomy (An operation through a larger incision) is necessary to repair an injury.
Anaesthesia may carry a small risk. Problems may arise with the medications given.
Complications are very rare under experienced hands. Hysteroscopic polypectomy is associated with major complication rate of less than 1 in 10000.
Are there any side effects?
It is usual to have some bleeding after hysteroscopy, which is bright red at first and should gradually reduces to a brownish discharge. This can last up to 2 weeks. Some degree of pain is to be expected but this is not severe and relieved by painkillers.
When do I follow up with the doctor?
The histopathology report takes approximately 5-7 days. You can follow up after a week to collect the report and to discuss further line of management.
Do polyps tend to recur?
In 10-15% of women there may be a tendency for polyps to recur. There are no medications which can prevent this. And the only treatment available is surgical removal. So if at all the polyp tends to recur in a women desirous of fertility, she may have to undergo a repeat surgery. It is therefore advisable to start treatment for fertility with a fertility specialist as soon as you get operated for a polyp.