Treating Endometrial Polyp Tissue
Endometrial or uterine polyps are a very common gynecological disorder in women, especially of childbearing age, and one of the most common causes of abnormal uterine bleeding, such as bleeding between periods. These polyps can be single or multiple and are found during the reproductive and postmenopausal phases of life. In other words, an overgrowth of the inner lining of the uterus which is called the endometrium leads to polyps. Their size varies from about 5 mm to the size of filling the entire uterine cavity. The polyp may consist of normal-cycling endometrium or simple to complex hyperplastic endometrium. It is rare for endometrial cancer to be found in women of older age groups.
Symptoms of uterine polyps
Often symptoms of polyps can be asymptomatic, but abnormal uterine bleeding is the most common symptom in about 68% of women. However, in younger women, abnormal bleeding is less common. Increasing age is the most common risk factor for their occurrence. The signs to look out for are:
Irregular menstrual bleeding – for example, having frequent, unpredictable periods of varying length and heaviness.
Bleeding between periods.
Excessively profuse menstruation.
Vaginal bleeding after menopause.
Having a problem conceiving and dealing with issues related to fertility.
Women with underlying fertility issues are more likely to be diagnosed with an endometrial polyp. Although small polyps often disappear on their own, they are present in about 25% of patients. However, malignancy occurring in polyps is rare and its risk increases with age. Postmenopausal women on hormone replacement therapy (HRT) and obese women have a higher incidence of endometrial polyps.
Causes of uterine polyps
Experts don’t know exactly why women develop uterine polyps, but in all likelihood they’re linked to changes in hormone levels. Each month, your estrogen levels rise and fall, causing the lining of your uterus to thicken and then shed during your period. Polyps form when too much of this lining grows.
One is age as they are more common in the 40s or 50s. This may be due to changes in estrogen levels that occur just before and during menopause. These can also occur if you are obese or have high blood pressure.
Transvaginal ultrasound (TVUS) is the investigation of choice for PE. It is best done on or around the 10th day of the menstrual cycle when the endometrium is thinnest. The use of color Doppler increases the sensitivity of the scan to diagnose PE. TVUS with saline instillation into the uterus increases the diagnostic accuracy of PE. It describes small endometrial polyps that might be missed in TVUS. At certain advanced stages, hysteroscopy or hysterosonography may also be recommended to patients. Hysteroscopic removal of PE remains the gold standard of treatment.
Hysteroscopic polypectomy is a daycare procedure that is done under anesthesia. The polyp after removal is sent for histopathological examination to exclude malignancy.
Link between PE and infertility
Although the reason is unclear, it has been found that there is a link between polyps and infertility. The location of the polyps could prevent the embryo from implanting in the uterus. These growths can block the cervical canal and even prevent sperm from fertilizing the egg. In primary infertility, the incidence of PE varies from 3.8% to 38.5%, and it is from 1.8% to 17% in secondary infertility. Different mechanisms are involved in it. It could also prevent the implantation of the embryo into the endometrium acting as a space occupying lesion. It is also believed that the polyps can create an inflammation of the lining of the uterus similar to an intrauterine device (Cu-T) disrupting the implantation of the embryo. Restoration of reproductive capacity does not depend on the size of the excised polyp.
Studies involving in vitro fertilization (IVF) patients have shown that hysteroscopic polypectomy before IVF leads to better chances of pregnancy. In some of them, after polypectomy, a spontaneous pregnancy was obtained while waiting for treatment. Asymptomatic endometrial polyp is a commonly encountered problem, which may affect 25% of women with unexplained infertility and may only be detectable on hysteroscopy. If these endometrial polyps are not diagnosed and treated properly, infertility treatments may not work.
Endometrial polyp resection by hysteroscopy has been shown to be a beneficial procedure when performed before the start of assisted reproduction treatments, such as intrauterine inseminations and in vitro fertilization (IVF).
(The author is a senior fertility specialist.)