Endometrial polyps

1999

Overgrowth of the endometrial lining can create polyps.

Polyps are fingerlike growths that attach to the wall of the uterus.

Vary in size from tiny to golf ball size and can be single or multiple.

Exact cause unknown, although there is a association with the amount of estrogen in the body.

Patients with endometrial polyps and who are premenopausal up to 67% have intermenstrual bleeding or abnormal uterine bleeding.

Polyps may be single or multiple, measuring for a few millimeters-centimeters and may be sessile or pedunculated.

They are localized hyperplastic overgrowth of endometrial glands and stroma around the vascular core forming a projection arising from the uterine fundus and extending toward the internal os.

Possible causes include: genetic, biochemical, and hormonal factors.

Factors that may increase the risk for endometrial polyps are:

Obesity

Tamoxifen, a treatment for breast cancer

Postmenopausal hormone replacement therapy

Family history of Lynch syndrome or Cowden syndrome.

Prevalence ranges from 7.8% to 34.9% and increases with age.

Most uterine polyps are benign.

The incidence of malignancy is 1.7% in premenopausal women and the risk in postmenopausal women is 5.4%.

Risk factors for their development includes:age, tamoxifen use, increased levels of estrogen either endogenous or exogenous, obesity, and the Lynch syndrome.

The chance of cancer is higher if postmenopausal, on Tamoxifen, or are experiencing heavy or irregular periods.

Endometrial polyps are common in women between 20 to 40 years of age.

May be asymptomatic.

Symptoms, they may include:

Menstrual bleeding that is not regular or predictable

Long or heavy menstrual bleeding

Bleeding between periods

Bleeding from the vagina after menopause

Infertility

Evaluation includes:

Transvaginal ultrasound

Hysteroscopy

Endometrial biopsy

Hysterosonogram

Can be diagnosed using transvaginal ultrasound with the sensitivity of 91% and a specificity of 90%.

Other diagnostic test includes saline infusion sonohysterography with a 95% specificity and a 92% specificity, diagnostic hysteroscopy with the sensitivity of 90% and specificity 93%, and hyserosalpingography sensitivity 98% specificity 35%.

Treatment

Should be removed because of the small risk for cancer.

Most often removed by hysteroscopy.

Sometimes, Dilation and Curettage can be done to biopsy the endometrium and remove the polyp.

Postmenopausal women who have polyps that are not causing symptoms may also consider watchful waiting.

Polyps should be removed if there is vaginal bleeding.

Polypectomy can be performed with hysteroscopy.

Asymptomatic polyps greater than 1 1/2 cm and symptomatic polyps are considered for excision and sent for pathology exam.

Cervical polyps occur mostly in reproductive years especially after age 40.

Cervical polyps arise from endocervix potentially from inflammation and hormonal factors.

Cervical polyps are rarely larger than three cm.

Cervical polyps are rarely malignant and are easily removed and sent for pathology.

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