Polyps

Definition
- Localised tumours within the mucosa of the uterine cavity
o Commonly benign, but can be palignant
- Polyps may be pedunculated or sessile
o Size may vary from a few mm up to 3-4cm
- Epidemiology
o Common findings in women regardless of gynaecological symptoms

Aetiology
- Unknown
- Postmenopausal women with symptomatic polyps (e.g. postmenopausal bleeding) carry the highest
risk of malignant endometrial polyp

Risk factors
- Increasing age
o Prevalence increases with age in the reproductive age
o Not known whether the prevalence increases with age in postmenopausal women
- Obesity
- Use of tamoxifen
- Hypertension
- Fibroids, cervical polyps, endometriosis

Symptoms
- History
o Mostly asymptomatic
o Abnormal uterine bleeding (intermenstrual bleeding, spotting, menorrhagia)
o Postmenopausal bleeding
Most common Sx of endometrial polyps in postmenopausal women
o Infertility
Reports show a prevalence of endometrial polyps in infertile women
Removing said polyps may improve fertility

Investigations
- Assess within 4 weeks if postmenopausal bleeding to rule out endometrial cancer
- Imaging
o Diagnosed by transvaginal ultrasound examination
- Others
o Hysteroscopy or by histological examination
o Installation of saline in uterine cavity increases sensibility of examination
Recommended if ultrasound positive

Differential diagnosis
- Submuceous fibroids

Treatment
- Indications for treatment
o Symptomatic endometrial polyp (e.g. abnormal uterine bleeding)
o Obesity
 o Infertility
o Exclude malignancy
- 25% of all endometrial polyps regress spontaneously
o Small polyps <10mm are more likely to regress than larger polyps
- When to leave it untreated?
o Small polyps AND
o Asymptomatic AND
o No risk of malignancy (i.e. not menopausal, no bleeding)
- Surgical
o Transcervical resection via hysteroscopy
Effective in women suffering from spotting, inter-menstrual bleeding, or
postmenopausal bleeding
o Curretage not recommended
Risk of leaving the polyp behind is quite large
- If bleeding (menorrhagia) present
o Concomitant resection of the endometrium in perimenopausal women should be
considered in order to reduce periodic blood loss and the risk of recurrent menorrhagia
- Preoperative treatment with local oestradiol
o Recommended in order to reduce the risk of such complications in postmenopausal women

Follow-up
- Review histopathology in case of atypical endometrial hyperplasia or malignancy