Everything you need to know about Uterine Polyps

Uterine polyps develop mostly in women who are between the age of 40 and 50 years than in younger women. They rarely occur in women under 20 years of age. Polyps can also occur after menopause in some women.[2]

Chances of growth of uterine polyps increase when a woman has high blood pressure or hypertension, is obese or overweight, or is taking tamoxifen. Tamoxifen is a drug that is used for treating breast cancer.

The exact reason why uterine polyps are formed is not known, but swing in hormone levels is considered a factor. Estrogen, which is a form of female sex hormone, plays a role in the growth of uterine polyps.

In general, polyps are estrogen sensitive. This means that polyps grow as a result of the estrogen circulating in the body. A few other reasons for the development of uterine polyps may be related to:[3]

• Jammed blood vessels
• Chronic redness or inflammation of the vagina, uterus, or cervix
• Increase in the levels of estrogen

The following are some of the symptoms of uterine polyps:

• Irregular menstrual periods:

In most women, periods last four to seven days. Periods generally occur every 21 to 35 days. More than half the women with uterine polyps have irregular periods, meaning menstrual periods that last longer than usual or occur at irregular intervals.

• Unusual and heavy flow during periods

Some women may experience menstrual bleeding lasting for longer than 7 days. Some may have very heavy bleeding, meaning they change tampons or pads in less than 2 hours.

• Spotting or Bleeding between periods

Some women with uterine polyps have bleeding or spotting between periods and after sexual intercourse.

• Vaginal bleeding after menopause

Uterine polyps can also cause bleeding after menopause in some cases.

• Infertility or Subfertility

The inability to conceive or carry a pregnancy may also be a sign that uterine polyps are present.

Unpredictable or irregular periods are the most common symptom of uterine polyps. It causes abnormal bleeding in almost 25 percent of the cases.[4]

The diagnosis of uterine polyps begins with your doctor asking about your menstrual history, which includes how often do you have periods and how long do they last. You should mention if you face any unusual symptoms like excessive bleeding or spotting or irregular periods. Your doctor may also ask you if you have had any difficulty in conceiving.

Your personal and family medical history will also be reviewed by your doctor followed by a physical exam which includes a pelvic examination.

Your doctor will perform a gynecological exam and may ask for certain additional tests or procedures. These recommended tests may include the following:[5]

Transvaginal ultrasound:

In this procedure, a slim handheld device known as an ultrasound transducer is inserted into the vagina. This device emits sound waves, which helps in providing an image of the interior of the uterus. This image also includes any irregularities that may be present in the uterus.

Sonohysterography:

This is a related procedure like a transvaginal ultrasound. Certain cases require this procedure to be performed after a transvaginal ultrasound. A thin tube called a catheter is used to introduce a sterile fluid into the uterus. This fluid causes the uterus to expand. This helps in providing a clearer image of any growths inside the uterine cavity during the ultrasound.

Hysteroscopy:

Hysteroscopy may either be used to diagnose or treat uterine polyps. In this procedure, a long, thin tube that has a lighted telescope is used. This tool is known as a hysteroscope. It is inserted through the vagina and cervix into the uterus. The hysteroscope enables examination of the inside of the uterus. In some cases, hysteroscopy can be used in combination with surgery to remove the uterine polyps.

Endometrial biopsy:

A soft plastic instrument is used by your doctor to collect tissue from the inner walls of the uterus. This tissue sample is sent to the laboratory to test and determine if any abnormalities are present within the uterus.

Curettage:

Curettage is performed in an operation theatre. This procedure helps in both diagnosing and treating polyps. Your doctor will collect tissue from the inner walls of the uterus using a long metal instrument called a curette. A curette has a small loop at its end which allows scraping tissue or polyps. These removed polyps or tissue are then sent to the laboratories for determining if cancer cells are present or not.

If the polyps are not causing any symptoms treatment may not be necessary. However, if the polyps cause heavy bleeding during periods, or if they are suspected of being cancerous or precancerous they should be treated. They should also be removed when they cause problems such as a miscarriage during pregnancy, or infertility in women who wish to conceive. If a uterine polyp is found out after menopause, it must be removed.

The following are the methods of treatment for uterine polyps:

Watchful waiting:

Polyps that are small in size and don’t produce symptoms may go away without any treatment. Patients with small polyps are monitored at their annual exams to check for any changes. Treating a small polyp is not unnecessary unless there is a risk of uterine cancer.

Medications:

There are drugs available that help in regulating the hormonal balance. Drugs like gonadotropin or progestins releasing hormone agonists can be utilized as a temporary treatment for uterine polyps. Hormone agonists are used to suppressing gonadotropin release and lower sex hormone levels in both sexes. These medications help in relieving symptoms like irregular or excessive bleeding. However, in most cases, the symptoms return once the medication is stopped. These medications are usually a short-term solution.

Hysteroscopy:

This procedure may be used either to diagnose or treat uterine polyps. In this procedure, a long, thin tube that has a lighted telescope is used. This tool is known as a hysteroscope. It is inserted into the uterus through the vagina and cervix. The hysteroscope enables examination of the inside of the uterus. In some cases, hysteroscopy can be used in combination with surgery to remove the uterine polyps. A small instrument is inserted through the hysteroscope for removing the polyps.

Curettage:

This procedure may sometimes be performed along with hysteroscopy. While a hysteroscope is used to look at the interior of the uterus, a curette is used along with it to scrape and remove any polyps present in the uterus. The removed polyps may be sent for testing to a laboratory to determine if they are cancerous or benign. This technique is most effective in smaller polyps.[6]

In a few cases, additional surgery may be required if the polyps are cancerous or if the polyps cannot be removed using any other methods. A hysterectomy is a surgical procedure which removes the entire uterus. Hysterectomy may be necessary in cases where cancer cells are present in the uterine polyps.

You may experience some soreness and slight bleeding for a day or two after your uterine polyp removal. These are common endometrial polyp treatment side effects. Avoid strenuous exercise, heavy lifting, sex, douching, and tampons until the spotting disappears.

In case if you have undergone a hysterectomy or a complicated procedure for removal, you will be kept in a recovery room as you wake up from general anesthesia. In some cases, the patient is required to stay in the hospital for a day or two, or longer.

You’ll be allowed to go home on the same day if you have undergone uterine polyp removal with local anesthesia. After the uterine polyps treatment, the polyps are sent to a lab for testing. This test confirms whether the polyps are cancerous or benign.

Slight tenderness and discomfort after the procedure are normal. You may also experience a period like pain. Your doctor will give you pain medication to soothe this. A heating pad or warm compress also helps relieve the discomfort.

Some women also have light bleeding immediately after a uterine polyp treatment and have a vaginal discharge for up to 14 days after the procedure. The discharge may be brown or light pink.

The menstruation cycle returns to normal after uterine polyp treatment. Women who have undergone a hysterectomy do not have periods because the procedure removes the entire uterus.

Use tampons for at least two weeks after your uterine polyp treatment is prohibited. It is advised to prevent strenuous exercises. You must wait until you have fully recovered to have sexual intercourse.

Complete recovery may take two weeks or longer after polypectomy and four to six weeks or longer in a hysterectomy. Recovery time differs from patient to patient and so, it is best to ask your doctor about when you should get back to work and other everyday activities.[7]

A follow-up appointment about a week after the uterine polyps treatment is recommended. This follow-up helps the doctor make sure that you are healing well. During this meet, you may also find out your lab results for the polyp.

It is not possible to prevent uterine polyps and so it is important to have regular gynecological check-ups. Risk factors like high blood pressure, obesity, or taking tamoxifen for the treatment of breast cancer may increase your chances of developing uterine polyps.

In a few cases, polyps return even after treatment. In such cases, additional treatment may be necessary. The rate of recurrence of endometrial polyps range from 2.5% to 43.6%, depending on the nature of the polyps and the follow-up duration.[9]

Uterine polyps are mostly not cancerous but some of them may turn cancerous later on. The chances of a uterine polyp turning cancerous are higher if you’ve gone through menopause.

Uterine Polyps also cause problems with fertility in some cases. However, it is uncertain as to how polyps contribute to subfertility and pregnancy loss as the mechanism is poorly understood. Polyps interfere with the reproductive processes like embryo implantation, sperm transport and even early pregnancy development.

Polyps can keep you from getting pregnant or cause a miscarriage. As these polyps grow inside of the uterus, they may disrupt the development of pregnancy. They may also prevent a fertilized egg (embryo) from successfully implanting itself in the uterine wall.

Additionally, in a few cases, uterine polyps block the area where the uterus and fallopian tubes connect (cornual portion). They may also block the entrance to the cervical canal which makes conception difficult.

Glycodelin is a secretory glycoprotein that inhibits sperm-oocyte binding. Glycodelin levels are very low between 6 days before and 5 days after ovulation in the endometrium. Low glycodelin levels help in facilitating fertilisation. Studies have observed that the fertilisation process is altered by increased glycodelin production in patients with uterine polyps.

Some studies have proven that removing uterine polyps helps women in getting pregnant. But there is no clear or one hundred percent proof that it works with everyone.[8] These studies indicate that removal of uterine polyps is also beneficial for natural conceptions, and conceiving through assisted reproduction technologies (ART).

Three different studies have found a relation between the removal of polyps and improved spontaneous pregnancy rates. These research studied infertile women that had endometrial polyps and infertile women without polyps. They found that the pregnancy rate is 78.3 % after removal of polyps when compared with 42.1 % in those with normal uterine cavities. Śpiewankiewicz reported a pregnancy rate of 76% and 19 out of 25 infertile patients conceived within 12 months after getting their polyps removed. These studies also suggest that women with unexplained infertility may also benefit from getting their polyps removed.[10]

Many pieces of research suggest that making the following changes in your diet may have health benefits. They may also lower chances of developing uterine polyps and thus improving your chances of conceiving:[11]

• Eating more vegetables, fruits, and foods that are high in fibre like beans, mango, apple, berries, banana, melons, etc.
• Eat more green leafy vegetables like spinach, kale, cabbage, etc.
• Eat more whole grains like Oats, rye, millet, barley, corn, etc.
• Eat more foods enriched in beta carotene like carrots and sweet potato
• Eat more flaxseeds

Foods to limit:

• Foods with high fat like fried foods
• Red meat
• Processed meat
• Avoid taking caffeinated beverages
• Avoid high intake of carbohydrates and sugar, pastries, sodas, candies, and others

Exercising is very helpful and quite effective. It helps in getting relief from the symptoms or in some cases uterine polyps themselves.

If you are overweight or obese, your body secretes more estrogen. This further aggravates the condition of uterine polyps. And therefore you should exercise every day to keep your body weight in check. Doing so will effectively help in shrinking the size of the polyps.

Certain yoga postures help in keeping the uterus healthy. These yoga postures improve the blood circulation to the uterus and in turn, strengthens it. The following are the most effective yoga postures to boost the uterus’s health:

• Moola Bandha asana
• Baddha Konasana
• Janu Sirsana
• Bhujangasana

Quick Tips:

• Ginger and garlic help in bringing symptomatic relief in uterine polyps. In some cases, Vitamin E is also known for helping in relieving symptoms.
• Quit drinking or smoking for reducing the risk of uterine polyps.
• If you have already undergone the surgery for the removal of uterine polyps, then it is advised to refrain from smoking for a month before and after the surgery.