Endometrial Polyps
What are
Endometrial Polyps?
Endometrial polyps are growths that develop from the lining of the uterus, known as the endometrium. They are usually benign (non-cancerous), although a small number may contain pre-cancerous or cancerous cells.
Polyps vary in size from only a few millimetres to several centimetres. They may occur as a single polyp or as multiple polyps within the uterine cavity. Some remain entirely within the uterine cavity, while others extend through the cervix into the upper vagina.
Although many polyps cause no symptoms, they can contribute to abnormal bleeding and, in some cases, affect fertility.
What is the cause of endometrial polyps?
The exact cause of endometrial polyps is not fully understood, but hormones are thought to play an important role in their development.
Oestrogen stimulates growth of the endometrial lining. When this stimulation occurs without sufficient balancing effects from progesterone, localised overgrowth of the lining may occur, resulting in the formation of a polyp.
Endometrial polyps are most commonly diagnosed in women who are premenopausal or perimenopausal, although they can also occur after menopause.
Factors associated with an increased risk include:
- obesity
- hypertension
- hormone replacement therapy (HRT)
- tamoxifen therapy for breast cancer.
Polyps may have either a broad base attached to the uterine wall (sessile polyps) or be attached by a narrow stalk (pedunculated polyps).
Symptoms and Problems Caused by Endometrial Polyps
Many women with endometrial polyps experience no symptoms, and the polyps are often discovered during investigations for another condition.
When symptoms do occur, they most commonly involve abnormal uterine bleeding.
Less commonly, polyps may interfere with fertility or, in rare cases, contain abnormal or malignant cells.
For this reason, all endometrial polyps should be assessed by a gynaecologist.
What symptoms can endometrial polyps cause?
Symptoms may include:
- heavy menstrual bleeding
- irregular menstrual periods
- bleeding between periods
- bleeding after menopause
- light spotting between menstrual cycles
- difficulty becoming pregnant.
Some women have no symptoms at all.
How can endometrial polyps affect fertility?
For women trying to conceive, endometrial polyps can reduce the likelihood of pregnancy.
Depending on their size and location, polyps may alter the shape of the uterine cavity, making it more difficult for sperm to reach the egg or for an embryo to implant successfully.
Polyps may also contribute to chronic inflammation within the uterine cavity, affecting the environment required for implantation.
In women undergoing fertility treatment, including intrauterine insemination (IUI) or in vitro fertilization (IVF), removal of endometrial polyps may improve pregnancy outcomes.
How are endometrial polyps diagnosed?
Your doctor will begin by discussing your symptoms and medical history.
Investigations may include:
- pelvic ultrasound
- saline infusion sonography (where appropriate)
- hysteroscopy.
A hysteroscopy allows your specialist to examine the inside of the uterus directly using a fine telescope passed through the cervix. If a polyp is identified, it can often be removed during the same procedure.
Treatment Options
Treatment depends on:
- whether symptoms are present
- the size and appearance of the polyp
- your age
- whether you have reached menopause
- whether fertility is a consideration.
Observation
Small polyps that are not causing symptoms may be monitored, particularly in premenopausal women.
Some polyps regress naturally without treatment.
Hysteroscopic polypectomy
The definitive treatment for an endometrial polyp is hysteroscopic polypectomy.
During this minimally invasive procedure, a hysteroscope is passed through the cervix into the uterus, allowing the polyp to be removed under direct vision.
The removed tissue is then sent for pathological examination to confirm the diagnosis.
Medication
Hormonal treatments, including oral progestogens or hormone-releasing intrauterine devices such as the Mirena, may be recommended to reduce the risk of further polyp formation following surgery.
Medication is generally not used as definitive treatment for an existing endometrial polyp.
What can I expect?
The outlook for women with endometrial polyps is generally excellent.
Most polyps are benign and can be removed using a straightforward hysteroscopic procedure.
Where polyps are contributing to abnormal bleeding or infertility, treatment often results in significant improvement in symptoms and may improve fertility outcomes.
What to remember
Endometrial polyps are a common cause of abnormal uterine bleeding and may also affect fertility.
Although most are benign, all polyps should be appropriately assessed because a small number may contain pre-cancerous or cancerous changes. If you experience abnormal bleeding or are having difficulty conceiving, further assessment may be appropriate.
Further information
For additional evidence-based information about uterine conditions, speak with your GP or gynaecologist or visit Jean Hailes for Women’s Health.
www.jeanhailes.org.au/health-topics/ovaries-and-uterus/polyps-and-ovarian-cysts
This article is intended for educational purposes only and should not replace personalised medical advice, diagnosis or treatment. Every article is written by a qualified specialist clinician and independently reviewed by a second specialist clinician to help ensure clinical accuracy and reflect current evidence-based practice.
