What is an Endometrial Polyp? What is Endometrial Polyp Treatment?

Endometrial Polyps are among the most commonly asked questions regarding women’s health. To explain the topic of endometrial polyps, we first need to define polyps. Polyps are small, often benign growths that can be found in various parts of the body, including the cervix, inside the uterus (endometrium), vocal cords, and intestines.

A polyp occurs when the layer of tissue lining the uterus (endometrium) grows excessively and protrudes into the uterine cavity.

This protruding tissue does not lose its connection to the endometrium. If this connection is very thin, it is called a pedunculated polyp. Pedunculated polyps can eventually sag out of the cervix over time. In some cases, the connection between the polyp and the endometrium extends over a wider area, resulting in broad-based polyps. Polyps typically occur in the upper part of the uterus.

What Are the Causes?

The exact causes of polyps are not well understood. However, endometrial hyperplasia is often seen together with the presence of polyps, suggesting that excessive estrogen activity may contribute to this condition. Endometrial polyps are commonly found in women undergoing tamoxifen therapy for breast cancer. Some studies suggest a possible genetic pathology association with polyps.

There is no relationship between smoking, contraceptive use, or the number of births and the occurrence of endometrial polyps.

How Common Are They?

Endometrial polyps are quite common. However, it is difficult to provide a precise figure for their frequency.

Some studies suggest that polyps are found in 50% of women, while the general consensus is that their frequency is around 10%. Additionally, about 7% of women experiencing postmenopausal bleeding have benign polyps as the underlying cause.

Polyps can occur in women of all ages, but they are most commonly found in women aged 39-50 years.

What Types of Polyps Are There?

Polyps can be categorized into different groups based on their shape and functional characteristics:

1) Hyperplastic Polyps: These are estrogen-dependent and share similar features to endometrial hyperplasia.

2) Functional Polyps: These contain secretory cells similar to the surrounding endometrium.

3) Adenomatous Polyps: These contain some muscle tissue.

4) Atrophic Polyps: These develop when hyperplastic or functional polyps lose their characteristics and shrink over time (atrophy).

5) Pseudopolyps: These are false polyps. They are typically less than 1 centimeter in size and appear in the second phase of the menstrual cycle, disappearing with menstrual bleeding.

What Are the Symptoms?

Most polyps do not cause any symptoms. They are usually discovered incidentally during examinations for other reasons or after uterine surgeries when undergoing pathological examination.

The most common symptom is bleeding disorders. Excessive menstrual bleeding or spotting between periods can indicate the presence of a polyp. Similarly, postmenopausal bleeding may also be caused by an endometrial polyp. Some women may experience brown discharge a few days after their menstrual period.

Polyp protrusions from the cervix may cause bleeding or pain after intercourse. In cases where a protruding polyp is present, it may be unclear whether it is a cervical polyp (originating from the cervix) or a true endometrial polyp.

The relationship between endometrial polyps, infertility, and recurrent miscarriages is debated. However, polyps are generally accepted as a cause of infertility. If an embryo implants on a polyp, it may not develop normally. Even when the polyp is located in the normal endometrial area, its presence can obstruct a healthy pregnancy. One study found endometrial polyps in approximately 24% of couples with infertility.

The likelihood of polyps becoming cancerous is extremely low.

How is the Diagnosis Made?

There are several methods used to diagnose endometrial polyps.

• The diagnosis of polyps is largely made through transvaginal ultrasound. However, your doctor may confuse pseudopolyps with real ones. Instead of routine ultrasound, saline infusion sonography (sonohysterography), which better visualizes the uterine cavity, is one of the most effective methods for diagnosing polyps. The sensitivity of routine transvaginal ultrasound in detecting polyps is 66%, while sonohysterography has 100% sensitivity.
• Hysterosalpingography can help detect larger polyps, but it is not very effective in diagnosing small ones.
• The gold standard for diagnosing polyps is hysteroscopy. The polyp can be visualized directly, and it can be removed during the procedure, providing both diagnosis and treatment.
• Polyps may also be found during curettage procedures performed to stop abnormal vaginal bleeding.
• Radiological examinations such as computed tomography and magnetic resonance imaging (MRI) can also detect polyps in the uterine cavity.

How is Treatment Done?

The majority of polyps do not cause symptoms. However, if a polyp is detected, it should be surgically removed. This procedure is called a polypectomy.

The most common treatment for polyps is removal via hysteroscopy. The procedure can be performed painlessly in an office setting. For patients who cannot tolerate office hysteroscopy, operative hysteroscopy under general anesthesia can be performed. The procedure is very quick, and the patient does not need to stay in the hospital; they can return to their normal activities within 1-2 hours.

There are several reasons why a polyp should be surgically removed when detected:

1. Confirming the diagnosis: To ensure that bleeding disorders are not caused by something other than the polyp, such as endometrial hyperplasia, which requires medical treatment.
2. Ruling out cancer: Postmenopausal bleeding is often associated with uterine cancer. Therefore, when a polyp is detected in postmenopausal women, it must be removed and sent for pathological examination to rule out underlying cancer.
3. Stopping the bleeding: The most definitive way to stop bleeding caused by a polyp is to remove the polyp itself.
4. Improving reproductive potential: If a polyp is found before pregnancy, either naturally or through IVF, removing the polyp may increase the chances of a successful pregnancy. A study showed that polyps smaller than 1.5 cm do not reduce pregnancy rates in IVF treatments but may increase the risk of miscarriage.

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