Endometrial Uterine polyps are excess tissues
that grow on the inner walls of your uterus. Uterine polyps can develop in
women of any age, but generally they develop in women during their 40’s and
50’s. Uterine polyps sometimes cause problem with fertility or can increase
your risk of miscarriage. A normal and healthy uterine cavity and endometrial
lining is necessary for a woman to conceive and maintain a healthy pregnancy.
Most of the polyps are very small and do not represent a compromise to
reproductive capabilities. But, larger and multiple polyps can interfere with
the reproduction and thus causing infertility or increases the risk of
miscarriage. Endometrial or uterine polyps are soft, finger like growths which
develop in the lining of the uterus (the endometrium). These are very common
benign growths; and are often found in infertile women. Endometrial or uterine
polyps are soft, finger like growths which develop in the lining of the uterus
(the endometrium). They develop because of excessive multiplication of the
endometrial cells, and are hormonally dependent, so that they increase in size depending
upon the estrogen level. They can usually be detected on an ultrasound scan if
this is done mid-cycle, when estrogen levels are maximal, but are easily missed
if the scan is not done at the right time of the menstrual cycle.
In addition, uterine polyps are an important
cause of dysfunctional menstruation, providing the basis for these symptoms in
certain women who have abnormal uterine bleeding. These polyps can also be a
risk factor for uterine cancer, as well.
(Such cancer is much less likely in Pre-menopausal women). Uterine polyps can become symptomatic in
women of any age but are more likely to become evident in per menopausal or
postmenopausal women (in whom they can cause light bleeding). Risk factors for uterine polyps include age,
menopause, and presence of cervical polyps. Most uterine polyps are
noncancerous but, when removed, they are sent to the lab for biopsy. If polyps are too expensive for hysteroscopic
removal or show signs of being precancerous or cancerous, the team may recommend
a hysterectomy.
How are Endometrial Polyps Diagnosed?
HSGs or Hysterosalpingogram are commonly
performed to determine if the fallopian tubes are open. A dye is injected into the uterus and passes
into the fallopian tubes. Therefore, an
image of the uterus is obtained in addition to determining whether the tubes
are open or obstructed. The image of the
uterus could reveal abnormalities within the uterus. Typically, these abnormalities are polyps,
fibroids, adhesions, and/or a uterine septum.
Another diagnostic test is a screening vaginal
sonogram. When this is performed in the
mid portion of a cycle (around the time of ovulation), abnormalities of the
endometrium may be discovered.
It may be necessary to remove the abnormality
and restore the uterus to normal. The
removal of these abnormalities is best performed by hysteroscopy, which
involves using a small scope that is passed through the cervix into the
intrauterine cavity so that the inside of the uterus can be visualized
directly. An anesthetic is utilized to
eliminate any discomfort from the procedure.
With direct visualization, a polyp can be removed without disturbing the
rest of the endometrium. Prior to hysteroscopy,
the polyps were removed by “blind” D&C.
A D&C involves scraping the entire lining of the uterus, expecting
that the polyp was being removed with the procedure. A blind D&C should be avoided if
possible, because there is always a risk of creating scar tissue in the uterus
from the procedure. The hysteroscopic removal of an endometrial polyp is an
outpatient procedure. It usually takes
less than one hour to complete. Patients
are asked to take off work the day of the surgery because of the anesthetic
sedation. However, patients are able to
return to work on the following day.
Need to know about Endometriosis first
Chief among symptomatic endometrial conditions
is endometriosis, an often-painful condition that can also affect fertility.
The condition brings discomfort that in some women can significantly detract
from quality of life. Endometriosis affects millions of women.
The clumps of uterine tissue that grow outside
of the uterus (“implants”) and around reproductive and other pelvic organs in
this disease get thicker during the menstrual cycle and then break down and
bleed. But because this tissue is
outside the uterus, the blood cannot be released normally. These areas can get irritated and sore. They
can also form scar tissue or fluid-filled sacs that may be painful and that can
affect fertility.
What will polyps do in our body?
Usually, uterine polyps nourish on estrogen
hormone. If you have more estrogen with uterine polyps, your polyps will grow
more and more. Once these polyps attain a certain size, then they swill tart to
protrude into your uterine cavity. The size of polyps ranges from a few
millimeters to several centimeters. Usually, polyps are attached to the uterine
walls by a large base or a thin stalk. During in some cases, these polyps are
slips down into the cervix.
How polyps affect your fertility?
Endometrial polyps have been found to be
associated with infertility. There is at
least one good study that revealed that removal of the polyp increases the
chances of conceiving. The study found
that when a polyp was removed, the pregnancy rate was 63%. However, if the polyp was not removed at
hysteroscopy, the pregnancy rate was only 28%.
Another study found that the most common area in
the uterus for an endometrial polyp to be found was on the posterior uterine
wall. Interestingly, polyps that were
found in the cornual portion of the uterus (the area of the opening of the
fallopian tubes into the uterus) were associated with a higher chance of
pregnancy when these polyps were removed compared to removing polyps from other
locations within the uterus. This
suggests that polyps in this location are more likely to be associated with
difficulty in conceiving. However, the
exact mechanism is unknown.
It has been speculated that a endometrial polyp
may cause irritation of the lining of the uterus interfering with implantation
of an embryo. These polyps can interfere with implantation, effectively
preventing an embryo from attaching to the uterine wall. It is common for
polyps to induce a chronic inflammatory response within the uterus, as the body
mounts a reaction to try to destroy the polyp. This may be the mechanism by
which polyps interfere with the establishment of a pregnancy. It is appropriate
that the uterus be evaluated during the fertility investigation. If an abnormality in the uterus is
discovered, it is recommended that the woman should undergo a hysteroscopy to
remove the abnormal.
What are the symptoms that you experience with uterine
polyps?
For some women polyps won’t cause any symptoms.
But some may experience symptoms such as:
·
Painful or heavy periods
·
Unpredictable or irregular menstrual bleeding
·
Vaginal bleeding even after the menopause
·
Infertility
What is Adenomyosis?
Sometimes abnormal growth of endometrial tissue
can result in the endometrium invading the muscle wall of the uterus is called
adenomyosis, this condition can cause discomfort due to swelling and
pressure. The symptoms are usually more
evident during the premenstrual portion of the menstrual cycle and the
condition occurs most often in women over 30 (especially in their 40s) who have
had a full-term pregnancy. Adenomyosis
can also cause additional bleeding during periods. The condition is a common
cause of cyclical menstrual pain and is sometimes referred to as internal
endometriosis. When endometrial tissue
is in the muscle wall it can trap blood that would normally be released with
the menses, resulting in cramping and prolonged bleeding. Adenomyosis can occur in the presence of
fibroids (for which it is often mistaken), cysts, or other gynecologic
conditions. Patients with the condition may also have endometriosis. Women who have previously had surgery to
their uterus (fibroid removal, C-section, etc.) are more likely to develop
adenomyosis than women who have not.
Adenomyosis can cause the uterus to become
enlarged. However, so can fibroids,
which produce similar bleeding symptoms, so the team must differentiate the
two, usually using pelvic ultrasound. Treatments are similar to those for endometriosis;
however, because of the depth of the tissue growths, laparoscopic endometrial
ablation may be of limited use.
Hysterectomy is considered the only treatment that is dependably
successful in relieving adenomyosis pain in most women. Some women, though, may chose conservative
care, knowing that symptoms of the condition usually disappear after menopause.
What are the treatments used to remove polyps?
Most of the polyps do not require any treatment.
But treatment is suggested for people who experience severe discomfort. They
include:
Hormone
medication - drugs such as progestin and GnRH agonists can be used to block
estrogen production and thereby shrink uterine polyps. These drugs induce an
artificial state of menopause so the patient is unlikely (and not advised) to
get pregnant until after the treatment is finished. Hormones may not be the
answer for infertility patients because the uterine polyps tend to grow back
when the treatment ends.
Surgical
removal - a surgical procedure called a hysteroscopic polypectomy is used to
take out uterine polyps. This is the treatment most likely to be offered to
infertility patients. The doctor inserts his surgical instruments into the
uterus via a Hysteroscope (a device which helps him see into the uterus) and
removes the polyps.
Hysterectomy - this
surgical procedure involves the removal of the uterus. This is the most radical
treatment used to remove uterine polyps and is usually performed only if the
uterine polyps are cancerous. Obviously, once the uterus has been removed, it
is not possible for the patient to become pregnant.
