- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Uterine polyps are abnormal, excessive growths (hyperplasia) of the glands and stroma of the uterus that extend from its inner lining and project into the uterine cavity. The overgrowth of cells in the endometrium leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually benign, although some may be cancerous or can eventually turn into cancer (precancerous polyps). Uterine polyps range in size from a few millimeters (about the size of a lentil) to several centimeters (the size of a golf ball or even larger). They are attached to the uterus by a broad base or a thin stalk.
A woman may have one or more uterine polyps. They are usually found in the body of the uterus, but occasionally they appear in the cervix as well as in the vagina. Uterine polyps occur more often in women who are going through or have completed menopause, although younger women may also develop them.
Symptoms of uterine polyps may include:
Hormonal factors appear to play a major role. Uterine polyps are estrogen-dependent, meaning they grow in response to circulating estrogen.
Risk factors for developing uterine polyps include:
Uterine polyps may be directly linked to infertility. If you have uterine polyps and are unable to have children, removing the polyps may allow you to get pregnant, but the evidence is unclear.
If your doctor suspects uterine polyps, one or more of the following diagnostic tests may be performed:
Most uterine polyps are benign. However, some precancerous endometrial changes (endometrial hyperplasia) or endometrial cancer may initially appear as polyps. Your doctor will likely recommend polyp removal so the tissue can be examined to rule out cancer.
Depending on your condition, your doctor may recommend:
In some cases, polyps may come back. Options include a hormonal IUD, which causes endometrial atrophy, or cauterization of the endometrium with diathermy (in women who no longer wish to have children).
In women being treated with tamoxifen, the picture is much more complex and management must be individualized.
The same term is often used, but these are two different lesions.
A woman can have both at the same time. That’s why, when a cervical polyp is found in a woman with bleeding, the endometrium is checked too.
Not every polyp needs to be removed. The decision is based on the risk of cancer, the symptoms and your plans for pregnancy. In large studies, the chance of cancer in a polyp in a premenopausal woman without symptoms is very low, below 1%. It increases after menopause, especially when there is bleeding.
Removal is recommended when:
Monitoring may be an option for a younger woman with a small polyp found by chance, with no symptoms and no plans for pregnancy in the near future. Some small polyps go away on their own within a year. The follow-up is done by ultrasound early in the cycle, right after the period, when the endometrium is thin and the polyp is easier to see.
The procedure is usually scheduled in the first days after your period ends. In women of reproductive age, pregnancy is ruled out first. If it is done under anesthesia, you need to fast from the night before and have preoperative tests.
Small polyps can be removed by office hysteroscopy, with a thin hysteroscope and without general anesthesia. Larger or multiple polyps are removed by operative hysteroscopy under sedation, with special instruments that cut the base of the polyp. The procedure usually takes 10 to 30 minutes, with no abdominal incisions.
The histology result usually comes back in one to two weeks. Contact us right away if you have a fever, bleeding heavier than a period, or pain that is getting worse. You will find more about the technique on the page about hysteroscopy.
Inside the cavity, a polyp acts like a foreign body. It can cause local inflammation and change the environment where the embryo implants. Especially when it is close to the openings of the fallopian tubes, it can also make it harder for sperm to pass through.
On a standard ultrasound, several conditions can look like a polyp. Telling them apart correctly changes the treatment:
Saline infusion sonography, and above all hysteroscopy with biopsy, provide the certainty that a standard ultrasound cannot.
After menopause, a polyp is managed more strictly. Any bleeding, even a single spot, needs investigation. If the ultrasound shows a polyp in a woman who is bleeding, removal and histological examination are the rule. The reason is simple: at this age, the chance that a precancerous change or cancer is hiding there is higher. More about the signs and diagnosis on the page about uterine cancer.
Women taking tamoxifen after breast cancer have polyps more often, and they are often larger. Do not stop the medication. But report any vaginal bleeding or change in discharge to your gynecologist right away.
Bring your previous ultrasounds with you. Comparing them helps show whether the polyp is growing or shrinking.
No method guarantees that a polyp will not appear. However, because polyps feed on estrogen, certain choices lower the likelihood:
After removal, one ultrasound the following year, or sooner if symptoms return, is enough for most women.
Many women ask whether the birth control pill is to blame for a polyp. Combined contraceptives contain a progestogen, which keeps the endometrium thin, and they are not considered a cause of polyps. The hormonal IUD actually has a protective effect. However, if you have breakthrough bleeding that continues beyond the first months of using a method, do not automatically blame the product: an ultrasound will show whether there is a polyp or another cause.
Most polyps are benign. A small percentage may contain precancerous or cancerous cells, more often after menopause or when there is bleeding. That’s why a polyp that is removed is always sent for biopsy.
With hysteroscopy. A thin camera passes through the vagina into the uterus and the polyp is removed under direct vision, without incisions. You go home the same day.
It can make embryo implantation harder. Removing it improves the chances of conception, which is why it is recommended before IVF or IUI.
Yes, in some women polyps reappear after months or years. Regular ultrasound monitoring is needed.
Irregular or very heavy periods, spotting between periods or after intercourse, bleeding after menopause and difficulty conceiving. Many polyps cause no symptoms at all and are found by chance on ultrasound.
Not always. Small polyps are often removed by office hysteroscopy, with local pain relief or no anesthesia at all. For larger or multiple polyps, or when the woman prefers it, the procedure is done under sedation and you go home the same day.
Usually from the next cycle, once the histology is benign and the bleeding has stopped. For fertility treatment, your doctor will set the right timing.
Yes. Some small polyps, mainly those under one centimeter, go away on their own within a few months. That’s why, in young women without symptoms, a follow-up check may be done before deciding on removal.
There is no strong evidence that a small polyp causes miscarriage. In women with recurrent miscarriage, however, the uterine cavity is checked and any polyps or other abnormalities are treated.
