Uterine Polyps

Uterine polyps are growths attached to the inner wall of the uterus (endometrium) that can protrude into the uterine cavity. They grow in response to estrogen and vary in size from just a few millimeters up to even golf ball size. Women with irregular menstrual cycles appear more prone to get them, especially those with polycystic ovarian syndrome (PCOS) and obesity due to the elevated estrogens associated with these conditions.

Studies point to a connection between infertility and endometrial polyps. One study found that when a polyp was removed, the pregnancy rate was 63%. However, if the polyp was not removed, the pregnancy rate was only 28%. Another study suggests that polyps found where the fallopian tubes open into the uterus are more likely to be associated with difficulty in conceiving. Uterine polyps may also increase the chance of miscarriage.

Uterine polyps especially in young women are commonly benign (noncancerous). Precancerous changes called endometrial hyperplasia or uterine cancers may appear as uterine polyps in 5% of postmenopausal women, but occur in only 1% of young women with polyps. Often women with uterine polyps have no signs or symptoms of having them. Signs and symptoms associated with polyps in young women include irregular menstrual bleeding. Menstrual periods may be frequent, unpredictable, and of variable length and heaviness. Uterine cramping may also be a presenting symptom.

The diagnosis of uterine polyps is made either with transvaginal ultrasound, sonohysterogram, hysterosalpingogram, or hysteroscopy. Sonohysterography (SonoHSG) involves having saline instilled into the uterus through a small rubber catheter so that the intrauterine cavity can be more effectively identified using the transvaginal ultrasound. A hysterosalpingogram (HSG) is an X-Ray of the uterus and fallopian tubes. A small catheter is inserted into the cervical canal so that radio-contrast dye can be injected. An X-Ray is then obtained to determine if the intrauterine cavity is normal and both fallopian tubes are open. Hysteroscopy involves the insertion of a thin telescope (hysteroscope) through the cervix so that the intrauterine cavity can be visualized. Uterine polyps can also be removed by operative hysteroscopy.

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