Uterine Polyps symptoms, diagnosis, and treatment

Who is affected by uterine polyps?

Age is a key factor in the likelihood of developing uterine polyps. They are most commonly found in individuals in their 40s and 50s, particularly during perimenopause, the transitional period leading to menopause. While polyps can occur after menopause (postmenopause), they rarely affect individuals under the age of 20.

Risk Factors of developing uterine polyps:

• If you are overweight (measuring at a BMI of 25 to 30) or obese (measuring at a BMI of above 30)
• If you have hypertension (high blood pressure)
• If you are using tamoxifen, a medication for treating breast cancer
• If you have undergone hormone replacement therapy involving high levels of oestrogen
• If you have Lynch syndrome or Cowden syndrome

Are uterine polyps common?

It is difficult to determine how common uterine polyps are, as they are often asymptomatic.

Without symptoms, many cases remain undiagnosed. However, research indicates that uterine polyps occur more frequently in certain groups, particularly in individuals who have gone through menopause, compared to those who have not.

Symptoms and Causes

Spotting or bleeding aside menstruation (abnormal vaginal bleeding) is the most common symptom of uterine polyps. This includes irregularities such as vaginal bleeding in post-menopausal women or disruptions to normal menstrual cycles.

A menstrual period lasts 3 to 7 days, and a cycle happens every twenty-one to thirty-five days. Individuals with uterine polyps often experience irregular periods.

Other symptoms of uterine polyps may include:

• Irregular menstrual periods (unpredictable in timing and flow)
• Heavy menstrual bleeding (excessive flow)
• Bleeding or spotting between periods (intermenstrual bleeding)
• Infertility, defined as difficulty becoming pregnant or carrying a pregnancy to term
• Spotting or bleeding in post-menopausal women, ranging in colour from pink, red or brown
• Bleeding after sexual intercourse

Sometimes, uterine polyps are discovered incidentally during an evaluation for a different condition. On rare occasions, a polyp may prolapse (slip through the cervix and into the vagina), which allows the doctor to detect it during a physical exam.

Are uterine polyps painful?

While it is uncommon for uterine polyps to cause pain, larger polyps may result in dull abdominal or lower back discomfort, resembling menstrual cramps.

What causes uterine polyps?

Although hormonal factors are suspected to play a significant role, their actual cause aren't fully understood. The hormone oestrogen stimulates the thickening of the endometrium during each menstrual cycle, and this process is thought to contribute to the growth of uterine polyps.

Notably, several risk factors for developing polyps are associated with high oestrogen exposure.

How are uterine polyps diagnosed?

Your doctor will take note of your medical history as well as your symptoms.

If you are post-menopausal, your doctor will ask about any unusual vaginal bleeding or spotting. If you are premenopausal, they may inquire about the specifics of your menstrual cycle, such as its duration, frequency, and regularity. Your doctor may also ask if you've experienced challenges with fertility and will do a gynaecological examination, which includes a Pap smear and pelvic examination.

To confirm the presence of polyps and rule out other potential issues, additional tests or procedures may be ordered, including:

• Transvaginal ultrasound: A slim ultrasound probe is inserted into the vagina, producing sound waves to create images of the uterus and any irregularities
• Sonohysterography: A transvaginal ultrasound is performed, after which a sterile fluid is introduced into the uterus using a catheter. This fluid enlarges the uterus, providing a clearer ultrasound image of any polyps
• Hysteroscopy: Direct visualisation of polyps is performed by a hysteroscope (a long, thin tube with a lighted telescope). The hysteroscope is passed through the vaginal canal, the cervix and into the uterus. The instrument is also used for polyp removal
• Endometrial biopsy: This is performed using a soft plastic instrument to collect tissue samples from the endometrium (lining of the uterus). The sample is then taken to the lab for examination and inspected for abnormal cells
• Curettage: Uterine tissue and polyps are scraped, removed and collected by a curette (A metal instrument with a small loop)

How are uterine polyps treated?

Treatment depends on your symptoms, risk factors for uterine cancer, and whether you have reached menopause. If the polyps are asymptomatic and you are in your reproductive years, monitoring may be sufficient, as they can sometimes resolve on their own.

However, treatment is often necessary for individuals who are post-menopausal or experiencing symptoms.

Treatment options include:

• Medications: Hormone-balancing medications, such as progestins or gonadotropin-releasing hormone agonists, may help manage symptoms temporarily. However, symptoms usually return once the medication is discontinued
• Uterine polypectomy: Polyps can often be removed during a hysteroscopy. This precise procedure allows the doctor to locate, visualise, and excise polyps simultaneously. Tissue from the removed polyps is typically sent for testing to determine if cancer cells are present
• Hysterectomy: If cancerous cells are detected in the polyps, a hysterectomy (surgical removal of the uterus) may be required

Do uterine polyps need to be removed?

Whether you decide to remove uterine polyps or not depends on many factors. If you are premenopausal and not experiencing any symptoms, the polyp is considered low-risk and may not require removal. However, if you are post-menopausal or experiencing symptoms such as abnormal bleeding, your doctor may suggest removal.

Additionally, polyps may need to be removed if they are likely to interfere with pregnancy or negatively affect fertility.

Is uterine polyp removal painful?

Before the surgical procedure, your doctor will provide medications to ensure you do not feel pain. Despite this, you may experience mild pulling sensations or pressure during the procedure.

Are uterine polyps preventable?

Although uterine polyps can't be prevented, regular gynaecological check-ups can aid in detecting polyps early, allowing for timely treatment before they cause unpleasant symptoms or complications.

What can I expect if I have uterine polyps?

The prognosis for uterine polyps following removal is highly favourable. Studies reveal that symptom relief occurs in 75% to 100% of cases after polyp removal.

Recurrence of polyps is rare, and if it happens, your doctor can recommend further treatments. Although polyp removal may potentially address fertility issues, further research is needed to confirm this benefit.

Should I worry about uterine polyps?

Only a minute number of uterine polyps become cancerous. If you belong to a high-risk group for developing cancer, your doctor can recommend removing the polyp. Moreover, the likelihood of complications from polyp removal is minimal.

What percentage of uterine polyps are cancerous?

Only about 5% of uterine polyps are cancerous. The risk of malignancy is higher in those who are post-menopausal or experiencing abnormal bleeding. In some cases, benign polyps can closely resemble precancerous conditions (endometrial hyperplasia) or uterine cancer (endometrial sarcomas). To clarify whether a polyp is cancerous, your doctor may perform a biopsy on the polyp tissue.

When to consult your doctor

You should consider making an appointment with your doctor if you experience any of the following:

• Vaginal bleeding or spotting after menopause
• Vaginal bleeding or spotting outside of your regular menstrual cycle
• Menstrual bleeding that is unusually heavy or irregular

Questions to ask your doctor

To ensure you have a clear understanding of your condition and treatment options, you may wish to ask your doctor the following questions:

• Are my abnormal bleeding symptoms caused by polyps?
• Am I at high risk for my polyps developing into cancer?
• At what stage would you recommend treatment instead of monitoring the polyp?
• Could the polyps affect my ability to conceive?
• Will treating the polyps impact my fertility?
• If treatment is necessary, will it influence the timeline for my pregnancy plans?

Conclusion

Abnormal bleeding can be an indicator of uterine polyps, particularly if you are post-menopausal. Although unusual bleeding can feel worrisome, most causes, such as polyps, are unrelated to uterine cancer. Nonetheless, it is essential to consult your doctor to confirm the cause. If there is any concern that a polyp may become cancerous or if it causes troubling symptoms, your doctor can safely remove it.

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