Imagine a condition that affects numerous women yet often remains unnoticed until it possibly disrupts one’s health significantly. Endometrial polyps are one of those medical conditions that may linger silently, affecting numerous women without initially showing symptoms.
Fortunately for the millions of females affected, recent advancements in the field of gynaecology have significantly improved the diagnosis and management of endometrial polyps. Innovations in imaging technologies and hysteroscopic techniques have enhanced the accuracy of diagnoses and the effectiveness of treatments, which is performed on a daysurgery basis.
Ongoing research is focused on understanding the molecular genetics of endometrial polyps to better predict their development and potential for malignancy, which could revolutionise the way these common gynaecological issues are approached and treated.
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Table of Contents
What Are Endometrial Polyps?
Endometrial polyps, also known as uterine polyps, are overgrowths of the lining of the uterus, the endometrium, that form projections from the surface of the uterine wall. They vary widely in size and can occur as single or multiple growths. Although generally benign, these polyps can range from a few millimetres to several centimetres in size and are often found during routine examinations or investigations for other gynaecological symptoms.
Between 10% to 24% of women worldwide experience endometrial polyps. These are often diagnosed in women undergoing evaluations for abnormal uterine bleeding or infertility. The incidence of endometrial polyps in women with primary infertility has been reported to range from 3.8% to 38.5%, while for secondary infertility, it ranges from 1.8% to 17%, according to the Journal of Obstetrics and Gynaecology Research.
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Causes & Risk Factors
The formation of endometrial polyps is believed to be closely linked to hormone levels within the body, particularly the levels of oestrogen.. This hormonal link is evidenced by their common occurrence during periods of hormonal fluctuation, such as perimenopause.
Certain medications, including hormone replacement therapy and tamoxifen, a drug used to treat breast cancer, have also been identified as potential risk factors. Lifestyle factors such as obesity and high blood pressure are also believed to contribute to the development of these polyps, particularly in the context of hormonal imbalances.
Additionally, research shows that increased endogenous oestrogen and exogenous oestrogen administration are risk factors for the formation of endometrial polyps. The incidence of endometrial polyps in women using tamoxifen has been reported to range from 8% to 36%.
Symptoms & Diagnosis
Many women with endometrial polyps do not experience any symptoms, especially when the polyps are small. However, when symptoms do occur, they often manifest as irregular or heavy menstrual bleeding, bleeding between periods, post menopausal bleeding abnormal vaginal discharge or as a contributing factor to infertility.
The likelihood of developing endometrial polyps increases with age, peaking in women aged 40 to 50 years. Approximately 50% of women with endometrial polyps are asymptomatic, with the polyps often being discovered during routine checks or unrelated medical examinations.
Diagnosis of endometrial polyps typically begins with an ultrasound, which can detect irregularities in the endometrium. However, the gold standard for diagnosis—and often treatment—is hysteroscopy, a procedure that allows doctors to view the inside of the uterus and perform necessary interventions, such as biopsies or polyp removal.
Treatment & Complications
Treatment for endometrial polyps is tailored to the individual’s symptoms, the size and number of the polyps, and reproductive plans. The only way to exclude malignant transformation is via excision as it allows for histological analysis and effective treatment for abnormal bleeding. However, in some cases, small, asymptomatic polyps that have a low risk of malignancy may be monitored rather than immediately removed. Some studies have shown spontaneous regression in < 1 cm polyps in asymptomatic premenopausal women hence observational treatment may be done as long as there are no symptoms of abnormal bleeding.
Malignant polyps
While most endometrial polyps are benign, about 1% to 3% can develop into cancer, particularly in postmenopausal women. When looking for predictors of malignancy or premalignancy in endometrial polyps, a size of >10 mm, postmenopausal status and abnormal uterine bleeding were all independent risk factors. In addition, vaginal bleeding increased the malignant potential of endometrial polyps by a factor of 10 compared with asymptomatic women in postmenopausal women.
Polyps and Fertility
In the reproductive age group, large or multiple endometrial polyps can contribute to infertility and increase the risk of miscarriage. In women in whom the only reason for subfertility was endometrial polyps, hysteroscopic polypectomy improved the rate of spontaneous conception regardless of size or number of polyps, which may be due to the normalisation of endometrial implantation factors.
Treatment
Hence the main indications of treatment would be patients with symptomatic polyps (abnormal bleeding), any postmenopausal patient, polyps > 1 cm and those keen for fertility. The surgical option of hysteroscopic polypectomy ( removal of polyp from the attachment to the uterine wall) as a day surgery procedure is commonly employed. This is usually performed under sedation or general anaesthesia for better tolerability of the patient. There is a higher incidence of concurrent endometrial hyperplasia (precancer) with endometrial polyps hence an endometrial biopsy (curettage) is often taken at the same time as the removal of the polyp.
These treatments are highly effective at removing polyps and alleviating symptoms, particularly abnormal bleeding and associated pain.
Following surgical removal, endometrial polyps have a recurrence rate of about 16% within two years. Managing this condition involves regular monitoring through ultrasound and medical consultations. For women experiencing symptoms or those with larger polyps, timely surgical intervention is often recommended to prevent potential complications.
Top FAQs on Endometrial Polyps
Are endometrial polyps cancerous?
- Most endometrial polyps are benign (non-cancerous), but a small percentage can contain cancerous cells, especially in postmenopausal women.
Can endometrial polyps affect fertility?
- Yes, especially large polyps can interfere with implantation or increase miscarriage rates.
Do all endometrial polyps need to be removed?
- Not all polyps need removal, especially small, asymptomatic ones in premenopausal women. The decision depends on symptoms, risk of malignancy, and patient’s reproductive wishes and preferences.
How often should women with endometrial polyps be monitored?
- Monitoring frequency depends on the size and symptoms of the polyps. Typically, annual check-ups are recommended, but more frequent monitoring may be necessary if the polyps are getting larger or symptomatic.
Is there a way to prevent endometrial polyps?
- While there is no guaranteed way to prevent endometrial polyps, maintaining a healthy lifestyle and managing hormone levels can help reduce the risk. A hormonal intrauterine device (mirena) may reduce recurrence by thinning the endometrium and can be considered for prophylactic prevention inserted at the time of hysteroscopic removal especially in recurrent polyps causing abnormal bleeding. Regular gynaecological check-ups also ensure early detection and management.
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Uterine & Endometrial Polyps Treatment in Singapore
Understanding endometrial polyps is crucial for effective management and preventing complications. Raising awareness and securing timely medical consultations can significantly improve outcomes for women affected by this condition. If you are experiencing symptoms related to endometrial polyps, or if you’re in a high-risk group, it is advisable to schedule a consultation with a gynaecologist.
At our clinic, we offer comprehensive information and treatments that address a wide range of women’s health issues, including uterine or endometrial polyps and. Our medical director Dr. Pamela Tan, practicing at the Thomson Medical Center (TLC Gynaecology Practice) in Singapore, is a specialist in obstetrics and gynaecology certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy, and cystectomy (womb, fibroid, and cyst removal). To schedule an appointment, please call +65 9039 1000 or send us a message.
In your best interest, please note that this blog is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.
SOURCES:
- Annan, J. J., Aquilina, J., & Ball, E. (2012). The management of endometrial polyps in the 21st century. The Obstetrician & Gynaecologist, 14(1), 33-38.
- Guideline No. 447: Diagnosis and Management of Endometrial Polyps. Bougie, OlgaRandle, ElizabethThurston, JackieMagee, BrydenWarshafsky, ChelsieRittenberg, David et al. Journal of Obstetrics and Gynaecology Canada , Volume 46, Issue 3, 102402
- Mayo Clinic. (n.d.). Uterine polyps: Diagnosis & treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/uterine-polyps/diagnosis-treatment/drc-20378713
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.