Endometrial Polyp

Endometrial polyp

A mass in the inner lining of the uterus. They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated). 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 into the vagina. Small blood vessels may be present, particularly in large polyps.

Signs & Symptoms

–     They often cause no symptoms.

–     Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.

–     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.

Causes

–     No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen.

–     Risk factors include obesity, high blood pressure and a history of cervical polyps. Taking Tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.

–     The use of an intrauterine system containing levonorgestrel in women taking tamoxifen may reduce the incidence of polyps.

Diagnosis

Endometrial polyps can be detected:

–     Vaginal ultrasound (sonohysterography)

–     Hysteroscopy and dilation and curettage.

Treatment

Polyps can be surgically removed using curettage 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 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.

If it is a large polyp, it can be cut into sections before each section is removed. If cancerous cells are discovered, a hysterectomy (surgical removal of the uterus) may be performed. A hysterectomy would usually not be considered if cancer has been ruled out. Whichever method is used, polyps are usually treated under general anesthetic.

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