What are endometrial polyps? Should they be removed?

Almost a quarter of all women develop uterine polyps—a localised overgrowth of the uterine lining (endometrium). They are attached to the inner wall of the uterus either flatly or with a pedicle and hang in the uterine cavity like a fruit on a stalk.

The polyps may be round or oval, single or multiple, and range in size from a few millimetres to a few centimetres, or larger. They are usually harmless, though sometimes they may be associated with menstrual problems or contribute to difficulty in conceiving by interfering with implantation. But the chance of malignancy is less than 1%.

CAUSE: The exact cause of polyps remains unknown. Hormones like oestrogen that is responsible for the endometrium to thicken each month (in the first half of the menstrual cycle) seem to be a contributing factor. Typically, polyps are more likely to develop in women between ages 40 and 50. The chances of developing polyps may increase if a woman is overweight, has high BP or diabetes.

SYMPTOMS: Polyps are often silent, diagnosed only during a transvaginal ultrasound or an examination of the uterine cavity through a hysteroscope. The most common symptom, however, is irregular or unpredictable vaginal bleeding. Other symptoms include prolonged or excessive menstrual bleeding (menorrhagia), bleeding between periods and bleeding after menopause or sexual intercourse. In about 25% of women with abnormal uterine bleeding, the cause of the problem is found to be endometrial polyps.

TREATMENT: It is usually not necessary to remove polyps if they are asymptomatic. However, polyps should be removed if they cause heavy bleeding during periods, or if they are suspected to be pre-cancerous or cancerous. They also need to be removed if they are considered to be contributing to infertility or miscarriages. The best way to take out polyps is through a hysteroscopy preferably with a resectscope. An annual check-up with a gynaecologist is recommended to detect a problem early enough so minimal treatment can prevent a major problem.
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