Endometrial Polyps

Endometrial Polyps

Endometrial Polyps

Definition
Endometrial polyps are localized overgrowths of the innermost uterine layer (endometrium) that project into the uterine cavity.
Such polyps may be

§         broad-based (sessile)

§         on a narrow stalk (pedunculated)

and rarely include areas of neoplastic (benign or malignant) growth.
 

Specifically

§         adenomatous hyperplasia (benign growth of the endometrium)

§         endometrial adenocarcinomas (malignant tumors of the glandular component of the endometrium)

have been reported in only 0.6% of cases of endometrial polyps.

 

Prevalence

The prevalence of polyps is estimated to be 10% to 24% of women undergoing

§         surgical removal of the uterus (hysterectomy)

§         localized endometrial biopsy

Endometrial polyps are rare among women younger than 20 years of age.
The incidence of these polyps rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause.

Symptoms
The most frequent symptom of women with endometrial polyps is

§         irregular, acyclic uterine bleeding (metrorrhagia), which is reported in 50% of symptomatic cases.

§         post-menstrual spotting is also common.

 

Less frequent symptoms include

§         prolonged and/or profuse uterine bleeding (hypermenorrhea, also called menorrhagia),

§         post-menopausal bleeding,

§         breakthrough bleeding during hormonal therapy.

 

Overall, endometrial polyps account for 25% of abnormal bleeding in both premenopausal and postmenopausal women.

 

Diagnosis

Endometrial polyps are often diagnosed by microscopic examination of a specimen obtained after endometrial biopsy or after D&C (dilation and curettage); the cervix is gradually dilated to allow removal of the uterine lining.

 

As with submucous fibroids, the diagnosis of polyps can be missed on physical exam if the uterus is not distended.
Therefore, these lesions are being increasingly diagnosed by techniques such as ultrasound and hysteroscopy.
 

§         During hysteroscopy, the uterine cavity is visualized by introducing a small camera on the end of a tube (hysteroscope) directly into the uterus through the vagina and cervix. Hysteroscopy with directed biopsy is particularly helpful in the diagnosis of small polyps within the uterine cavity.
 

§         Hysterography, a technique using X-rays to take pictures of the uterine cavity, is rarely helpful when polyps are small but may yield suggestive findings (e.g., a smooth space-occupying lesion) when the polyp is large.

 Treatment

§         The majority of cases of endometrial polyps are cured by thorough curettage.
This technique, which involves removing the endometrial lining of the uterus, is especially successful in the post-menopausal age group.
 

§         However, removal of polyps or other structural abnormalities may be missed by blind curettage, therefore, hysteroscopic-guided curettage is often useful.