An endometrial polyp or uterine polyp is a
mass
Mass is an intrinsic property of a body. It was traditionally believed to be related to the quantity of matter in a physical body, until the discovery of the atom and particle physics. It was found that different atoms and different elementar ...
in the inner lining of the uterus.
[
] They may have a large flat base (
sessile
Sessility, or sessile, may refer to:
* Sessility (motility), organisms which are not able to move about
* Sessility (botany), flowers or leaves that grow directly from the stem or peduncle of a plant
* Sessility (medicine), tumors and polyps that ...
) or be attached to the uterus by an elongated
pedicle
Pedicle or pedicel may refer to:
Human anatomy
*Pedicle of vertebral arch, the segment between the transverse process and the vertebral body, and is often used as a radiographic marker and entry point in vertebroplasty and kyphoplasty procedures
...
(
pedunculated
A peduncle is an elongated stalk of tissue. Sessility is the state of not having a peduncle; a sessile mass or structure lacks a stalk.
In medicine, a mass such as a cyst or polyp is said to be ''pedunculated'' if it is supported by a peduncle ...
).
[
] Pedunculated polyps are more common than sessile ones.
They range in size from a few millimeters to several centimeters.
If pedunculated, they can protrude through the
cervix
The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
into the
vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
.
[
] Small blood vessels may be present, particularly in large polyps.
Signs and symptoms
![Uterine Polyps](https://upload.wikimedia.org/wikipedia/commons/5/5c/Uterine_Polyps.png)
They often cause no symptoms.
Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (
menorrhagia
Heavy menstrual bleeding (HMB), previously known as menorrhagia or hypermenorrhea, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding
Abnormal uterine bleeding (AUB), also known as (AVB) or as atypical ...
), and vaginal bleeding after
menopause
Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...
.
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.
If the polyp protrudes through the cervix into the vagina, pain (
dysmenorrhea
Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the ...
) may result.
Cause
No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating
estrogen
Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal acti ...
.
Risk factors include
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
,
high blood pressure
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
and a history of
cervical polyps.
Taking
tamoxifen
Tamoxifen, sold under the brand name Nolvadex among others, is a selective estrogen receptor modulator used to prevent breast cancer in women and treat breast cancer in women and men. It is also being studied for other types of cancer. It has b ...
or
hormone replacement therapy
Hormone replacement therapy (HRT), also known as menopausal hormone therapy or postmenopausal hormone therapy, is a form of hormone therapy used to treat symptoms associated with female menopause. These symptoms can include hot flashes, vaginal ...
can also increase the risk of uterine polyps.
The use of an
intrauterine system
A hormonal intrauterine device (IUD), also known as a intrauterine system (IUS) with progestogen and sold under the brand name Mirena among others, is an intrauterine device that releases a progestogenic hormonal agent such as levonorgestrel in ...
containing
levonorgestrel
Levonorgestrel is a hormonal medication which is used in a number of birth control methods. It is combined with an estrogen to make combination birth control pills. As an emergency birth control, sold under the brand name Plan B One-Step among ...
in women taking tamoxifen may reduce the incidence of polyps.
Diagnosis
![Myometrium versus endometrial stroma versus endometrial polyp stroma](https://upload.wikimedia.org/wikipedia/commons/7/75/Myometrium_versus_endometrial_stroma_versus_endometrial_polyp_stroma.jpg)
Endometrial polyps can be detected by
vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
l
ultrasound
Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
(sonohysterography),
hysteroscopy
Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
Hysteroscope
A hyst ...
and
dilation and curettage
Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a gynecolog ...
.
Detection by ultrasonography can be difficult, particularly when there is
endometrial hyperplasia
Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus.
Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of t ...
(excessive thickening of the endometrium).
Larger polyps may be missed by curettage.
Endometrial polyps can be solitary or occur with others.
They are round or oval and measure between a few millimeters and several centimeters in diameter.
They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.
The polyps consist of dense, fibrous tissue (
stroma), blood vessels and glandlike spaces lined with endometrial
epithelium
Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...
.
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.
Pedunculated polyps are more common than sessile ones.
Treatment
Polyps can be surgically removed using
curettage
Curettage ( or ), in medical procedures, is the use of a curette (French, meaning scoopMosby's Medical, Nursing & Allied Health Dictionary, Fourth Edition, Mosby-Year Book 1994, p. 422) to remove tissue by scraping or scooping.
Curettages are ...
with or without hysteroscopy.
When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping
forceps
Forceps (plural forceps or considered a plural noun without a singular, often a pair of forceps; the Latin plural ''forcipes'' is no longer recorded in most dictionaries) are a handheld, hinged instrument used for grasping and holding objects. Fo ...
at the beginning of the curettage procedure.
Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through the
cervix
The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
. Large polyps can be cut into sections before each section is removed.
The presence of
cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
ous cells may suggest a
hysterectomy
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.
Usually performed by a gynecologist, a hysterectomy may b ...
(surgical removal of the uterus).
A hysterectomy is usually not considered when cancer is not present.
In either procedure,
general anesthetic
General anaesthetics (or anesthetics, see spelling differences) are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma ...
is typically supplied.
The effects of polyp removal on fertility has not been studied.
Prognosis
Endometrial polyps are usually
benign
Malignancy () is the tendency of a medical condition to become progressively worse.
Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malign ...
although some may be
precancerous
A precancerous condition is a condition, tumor or lesion involving abnormal cells which are associated with an increased risk of developing into cancer. Clinically, precancerous conditions encompass a variety of abnormal tissues with an increased ...
or
cancerous
Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Poss ...
.
About 0.5% of endometrial polyps contain
adenocarcinoma
Adenocarcinoma (; plural adenocarcinomas or adenocarcinomata ) (AC) is a type of cancerous tumor that can occur in several parts of the body. It is defined as neoplasia of epithelial tissue that has glandular origin, glandular characteristics, or ...
cells. Polyps can increase the risk of
miscarriage
Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...
in women undergoing
IVF
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) f ...
treatment.
If they develop near the
fallopian tube
The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ot ...
s, they may lead to difficulty in becoming pregnant.
Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.
Untreated, small polyps may regress on their own.
Epidemiology
Endometrial polyps usually occur in women in their 40s and 50s.
Endometrial polyps occur in up to 10% of women.
It is estimated that they are present in 25% of women with abnormal vaginal bleeding.
See also
*
Cervical polyp
*
Uterine fibroids
Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Most women with fibroids have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bl ...
References
External links
{{Diseases of the pelvis, genitals and breasts
Noninflammatory disorders of female genital tract