Endometrial polyp

An endometrial polyp or uterine polyp is a polyp or lesion in the lining of the uterus (endometrium) that takes up space within the uterine cavity. Commonly occurring, they are experienced by up to 10% of women.^[1] They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).^[1][2] Pedunculated polyps are more common that sessile ones.^[3] They range in size from a few millimeters to several centimeters.^[2] If pedunculated, they can protrude through the cervix into the vagina.^[1][4] Small blood vessels may be present in polyps, particularly large ones.^[1]

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Cause and symptoms

No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen.^[2] They often cause no symptoms.^[3] Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.^[2][5] Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.^[6] If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.^[4]

Diagnosis

Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.^[2] Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium).^[1] Larger polyps may be missied by curettage.^[7]

Treatment

Polyps can be surgically removed using curettage or hysterescopy.^[8] When curettage is performed, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure.^[6] During hysterescopy, the polyp can be visualized and removed through the cervix. If it is a large polyp, it can be cut into sections before each section is removed.^[6] If cancerous cells are discovered, a hysterectomy may be performed.^[2] A hysterectomy would usually not be considered if cancer has been ruled out.^[6] Whichever method is used, polyps are usually treated under general anesthetic.^[7]

Prognosis and complications

Endometrial polyps are usually benign although some may be precancerous or cancerous.^[2] About 0.5% of endometrial polyps contain adenocarcinoma cells.^[9] Polyps can increase the risk of miscarriage in women undergoing IVF treatment.^[2] If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.^[2] Although treatments such as hysterescopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.^[6]

Risk factors and epidemiology

Endometrial polyps usually occur in women in their 40s and 50s.^[2] Risk factors include obesity, high blood pressure and a history of cervical polyps.^[2] Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.^[2][10] Endometrial polyps occur in up to 10% of women.^[1] It is estimated that they are present in 25% of women with abnormal vaginal bleeding.^[10]

Structure

Endometrial polyps can be solitary or occur with others.^[11] They are round or oval and measure between a few millimeters to several centimeters in diameter.^[11][6] They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.^[6] The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium.^[6] If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall.^[11] Pedunculated polyps are more common than sessile ones.^[3]

See also

• Cervical polyp
• Uterine fibroids

References