Authored By: Dr. Vinatha Puli
MBBS, DGO, DFSRH, MRCOG, CCT (UK)
Clinical Director – Obstetrics & Gynaecology
What are uterine polyps?
Uterine polyps or endometrial polyps are the growths that happen with in the lining of the uterus (womb- where in the baby grows in pregnancy).
The polyps can be attached to the lining of the uterus by a thin stalk or thick broad base. They are usually no cancerous although sometimes we have to rule out precancerous or cancerous changes in them. Polyps can sometimes cause irregular bleeding or problems with fertility
Who can have uterine polyps?
Uterine polyps are more likely to develop in women of 40-50 years age. They can also happen after menopause but rare in women under 20 years Women who are overweight or obese or those with high Blood pressure or those who use tamoxifen (medicine used in treatment of breast cancer) are more likely to develop uterine polyps.
What are the reasons & why some women develop uterine polyps?
The exact reasons are unknown Hormonal changes especially retrograde plays a role in causing the lining of the uterus to get thickened and thereby causing polyps.
What symptoms can women have when they have uterine polyps?
Women might experience heavy menstrual bleeding, irregular or unscheduled bleeding, spotting or bleeding in between periods, fertility problems. Most of the time polyps might not cause any problems and are detected at scans done for various other reasons.
What tests are done to know if there is uterine polyp or not?
After taking details of your symptoms and thorough clinical examination your doctor might ask for ultrasound scan. Pelvic ultrasound done from vagina is used to detect uterine polyps. As ultrasound uses only sound waves it is safe. Sometimes it is challenging to detect some polyps especially if lining is thicker or irregular.
Saline can be passed through vagina into the uterus and scan done to get clear view of inside of the uterus. This is called saline sonogram or sonohysterogram. Sometimes biopsy done for lining if uterus can detect polyps. However polyps can be missed at biopsy.
Hysteroscopy is considered to be good standard test to detect and treat uterine polyps. A small camera is passed through vagina and cervix into the uterus and fluid is used to distend the uterine cavity. Direct visualisation of lining of uterus is possible through this test. Major advantage is removal of polyps can be done at same time as the test.
What treatment options are available for uterine polyps?
Not all polyps need removal especially if women don’t have symptoms. However if irregularities of bleeding or polyps that are suspicious of cancer or precancerous or in women with history of miscarriages or fertility problems and in women polyps are noted after menopause removal is suggested.
Medications – hormones like progesterone can be used for temporary treatment. Hysteroscopy and polyp removal is generally the treatment of choice. It enables not only the diagnosis but also ensures complete removal of polyp under vision thereby reducing the regrow of the polyp. Some polyps might reoccur despite complete removal. Just doing curettage without using the cope is not ideal. Additional surgeries might be required if polyps are precancerous or cancerous or recurrent.
Can we prevent formation of uterine polyps?
There is no way to prevent formation of polyps. However by reducing obesity and controlling high blood pressure we can prevent polyps indirectly.
Those who are on tamoxifen medicine for breast cancer will need regular gynaecology check up to detect early. In some premenopausal women who have recurrent polyps and those who have completed family LNG -IUS (progesterone hormone containing coil) has shown to reduce the recurrence.