Endometrial Polyps (Uterine Polyps) – Symptoms, Causes, and Treatment

What Are Endometrial Polyps?

Endometrial polyps are small tissue growths arising from the endometrium, the lining of the uterus. Polyps may be round or oval in shape, and typically range in size from a few millimetres to several centimetres. They are attached to the wall of the uterus with a small stalk or broad base.

Unlike uterine fibroids, which arise from the muscle layer of the uterus, endometrial polyps develop from the lining, which is also soft and primarily made of endometrial tissue. Most commonly, endometrial polyps occur in women aged 40-50, but younger women and women after menopause can develop polyps as well. Asymptomatic polyps are often found incidentally during imaging or fertility work-ups.

Symptoms of Uterine Polyps

While some women do not show any symptoms at all, others experience irregular bleeding. Possible signs of endometrial polyps include the following:

• Irregular or heavy periods: The period may become longer than usual or heavier than usual.
• Spotting between menstrual periods: Occasionally, spotting or light bleeding may occur at unexpected times.
• Infertility or difficulty getting pregnant: Polyps can affect the travel of sperm through the uterus or the implantation of the fertilised egg.
• Bleeding after menopause: Any bleeding after menopause is unusual and needs evaluation.
• Pelvic pain: There may be a dull aching or full feeling in the lower abdomen.

A gynaecologist should always evaluate any persistent or unusual bleeding, as it may indicate uterine polyps or other uterine issues.

Types of Endometrial Polyps

Endometrial polyps vary in their structure, cellular activity, and hormonal responsiveness.

Understanding the types of endometrial polyps enables doctors to choose the most appropriate diagnostic and treatment methods.

How Are Uterine Polyps Diagnosed?

Uterine polyps can be diagnosed through various imaging and evaluation methods. Most are tests that allow the clinician to visualise the uterus and diagnose the polyps.

Some methods for diagnosis are:

• Ultrasound: A transvaginal ultrasound may show thickening of the uterine lining, or visible polyps can be seen on TVUS.
• Sono hysterography: This is an ultrasound procedure where sterile saline is infused into the uterus, and then a clearer view of the uterus cavity can be achieved while measuring the polyp location.
• Hysteroscopy is the gold standard for polyp diagnosis and treatment, a procedure in which a small camera is inserted through the cervix to visualise and remove polyps simultaneously.
• Endometrial biopsy: This may be performed to evaluate for malignant cells, especially if a woman has abnormal bleeding; this is more common in post-menopausal women.

These diagnostic procedures will not only help identify the location of the polyps but also diagnose their size, number, and any risk that endometrial polyps may pose.

Treatment Options for Endometrial Polyps

The size and number of polyps, as well as their symptoms and effects on fertility, will help determine management options. Small, asymptomatic polyps may frequently resolve spontaneously.

The most common treatment options are:

• Watchful Waiting: Common for small, asymptomatic polyps. Periodic ultrasound monitoring will detect any change.
• Medication: Hormonal therapy with progestins or gonadotropin-releasing hormone (GnRH) agonists may result in polyp shrinkage or improvement in bleeding symptoms; however, symptoms often return once treatment is stopped.
• Surgical Treatment: Hysteroscopic polypectomy is the safest and most effective minimally invasive approach. It is performed under light anaesthesia, allowing for removal and biopsy in the same setting. Larger polyps or multiple polyps may require dilation and curettage (D&C), but hysteroscopic procedures are better because they are more accurate and less invasive.
• Post-treatment Care: Follow-up appointments are scheduled for evaluation of complete removal and to assess for recurrence. Even lifestyle changes, such as achieving a healthy weight and optimising the hormonal milieu, are considered effective strategies for reducing polyp regrowth.

The treatment is especially beneficial for alleviation of abnormal bleeding and improvement of fertility treatment, especially when done as a pre-treatment for IUI or IVF, and even for natural conception attempts.

How to Prevent Polyps in the Uterus?

While not all polyps in the uterus can be prevented, choices regarding food and hormones can greatly reduce the likelihood.

Practical prevention options to consider include the following:

• Maintain a healthy weight: maintaining a healthy weight helps decrease the amount of oestrogen produced from fat in the body.
• Regulate your hormone levels: A balanced cycle and hormones will help regulate the growth of endometrial tissue.
• Yearly doctor visits: Early diagnosis of polyps or endometrial tissue growth will help prevent complications.
• Manage your hypertension and diabetes: if you have chronic hypertension and diabetes, your risk for the development of polyps and changes in the uterus increases.
• Eat a balanced diet: A diet that includes fibre, antioxidants, and phytoestrogens (e.g. soy) in moderation is encouraged.

Maintaining healthy habits can significantly reduce the risk of uterine polyps and is beneficial for overall reproductive health.

Can Endometrial Polyps Affect Fertility?

Yes. Endometrial polyps can impede fertility through their alteration of the uterine environment needed for the implantation of an embryo. Polyps may also block the cervical canal or the openings of the fallopian tubes, preventing the sperm from reaching the egg. Sometimes, the mere presence of polyps can alter the uniformity of the endometrium, making it difficult for an embryo to implant.

The Good News: Polypectomy (surgical removal of polyps) greatly improves the chances of pregnancy, whether it is spontaneous or through assisted reproductive methods such as IVF. Studies have indicated that women who have undergone hysteroscopic removal of polyps before IVF have significantly improved implantation and live birth rates compared to women who have not.

Conclusion

Endometrial polyps are common benign lesions of the uterus that can cause irregular bleeding, postmenopausal spotting, or fertility issues. However, thanks to modern diagnostic tools and minimally invasive treatments, managing suspected polyps is safer and easier. Regular gynaecological check-ups, consistent hormone management, and prompt medical attention for abnormal symptoms can lead to earlier diagnosis and better reproductive outcomes.