Endometrial Polyps

definitions

Endometrial polyps are noncancerous (benign) growths that develop in the inner lining of the uterus, known as the endometrium. They are composed of glandular, stromal, and blood vessel tissue. They may be single or multiple, and have a broad base or are attached to the endometrium by a thin root (peduncle).

Size and appearance

The size of polyps ranges from a few millimeters to several centimeters.

They are often mobile and appear as soft masses within the uterine cavity.

They can emerge through the cervix and be seen in the vagina in rare cases.

Distribution

Polyps are divided into:

• Benign (most common)

• Atypical (with cellular changes)

• Malignancy (very rare, but more common in postmenopausal women)

The most common symptoms

Many women are asymptomatic, but if symptoms appear, they include:

• Abnormal uterine bleeding, such as:

• Intermenstrual bleeding

• Prolonged or very heavy menstruation

• Postmenopausal bleeding

• Unusual vaginal discharge

• Pain during menstruation (rare)

• Infertility or difficulty getting pregnant

  
  

Causes and Risk Factors

The reasons why endometrial polyps form are not fully known, but some influencing factors are:

• High estrogen levels

• Age over 40-45 years old

• Obesity (due to aromatization of estrogen in adipose tissue)

• Arterial hypertension

• Tamoxifen (used to treat breast cancer)

• Hormone replacement therapy

• Personal or family history of endometrial polyps or cancer

Troubleshooting

The most common methods for diagnosing endometrial polyps:

• Transvaginal ultrasound

• It detects the thickness of the endometrium or small masses within the uterine cavity.

• Sonohysterography (SIS) A technique that involves injecting saline solution into the uterus to enhance the ultrasound image.

• Diagnostic hysteroscopy

• Allows direct visualization of polyps with an optical instrument inserted through the vagina and cervix.

• Endometrial biopsy

• It is used to rule out malignancy, especially in postmenopausal women or those at increased risk.

treatment

The decision for treatment depends on the symptoms, the size of the polyp, and the woman's reproductive status.

Options include:

• Clinical surveillance: If polyps are small and asymptomatic, they can be followed with periodic checkups.

• Removal by operative hysteroscopy: The most effective treatment. The polyp is removed and sent for histopathological analysis.

• Curettage (D&C): Less accurate and less commonly used today without hysteroscopy.

• Hormone therapy: In special cases, to reduce symptoms, but does not definitively solve the problem.

When should you go to the doctor?

Consult a gynecologist if:

• You have bleeding outside of your cycle.

• You have bleeding after menopause.

• You have fertility problems.

• Ultrasound revealed unexplained endometrial thickening.