ENDOMETRIAL/UTERINE POLYPS

DEFINITION
 Benign localized overgrowth of endometrial glands and stroma,
covered by epithelium, projecting above the adjacent epithelium
or
 An endometrial polyp or uterine polyp is a mass in the inner
lining of the uterus.
 They may have a large flat base (sessile) or be attached to the
uterus by an elongated pedicle (pedunculated) Pedunculated
polyps are more common than sessile ones. They range in size
from a few millimeters to several centimeters.
 If pedunculated, they can protrude through the cervix into
the vagina
 RISK FACTORS/ AETIOLOGY
 No definitive cause of endometrial polyps is known, but they
appear to be affected by hormone levels and grow in response to
circulating estrogen

Risk factors include:

 Obesity and overweight

 high blood pressure

 history of cervical polyps

 Taking tamoxifen or hormone replacement therapy can also

increase the risk of uterine polyps.
 Chronic inflammation

NOTE
 The use of an intrauterine system containing levonorgestrel in
women taking tamoxifen may reduce the incidence of polyps.
 EPIDEMIOLOGY
 More common in women > 40
 Endometrial polyps occur in up to 10% of
women.
 It is estimated that they are present in 25% of
women with abnormal vaginal bleeding.
 CLINICAL FEATURES
 They often cause no symptoms, but where they occur
may present with:
 irregular menstrual bleeding

 bleeding between menstrual periods (intermenstrual

bleeding)
 excessively heavy menstrual bleeding (menorrhagia),

 vaginal bleeding after menopause (post-menopausal

bleeding)
 If the polyp protrudes through the cervix into the vagina,
pain (dysmenorrhea) may result
 Infertility

 Persistent bleeding following curettage

 CLINICAL FEATURES….
 Vaginal discharge: Uterine polyps may cause watery,
bloodstained discharge to be excreted from the vagina. Discharge
can become foul smelling as well.
 Cramping: Particularly large polyps may push down into the
cervical canal, causing discomfort and cramping. These
protruding growths can be seen during routine pelvic
examinations by a gynecologist.
 CLASSIFICATION
 Hyperplastic

• resemble diffuse non polypoid endometrial hyperplasia

• no evidence that these have the same significance as
diffuse hyperplasia, so best to avoid the term hyperplastic
in the diagnosis
 Atrophic

• low columnar or cuboidal cells lining cystically dilated

glands
• typically in post-menopausal patients
 Functional

• resemble normal cycling endometrium

• relatively uncommon
 DIAGNOSIS
 Endometrial polyps can be detected
 Vaginal ultrasound: Note: can be difficult, particularly when there is
endometrial hyperplasia
 Hysteroscopy: and 

 dilation and curettage: Note: Larger polyps may be missed by

curettage
 Endometrial biopsy: Using a soft plastic instrument, a small piece of
the polyp is removed to be examined for cancer cells
 Endometrial polyps can be solitary or occur with others.

 They are round or oval and measure between a few millimeters and
several centimeters in diameter
 They are usually red/brown color of the surrounding endometrium the
large ones can appear darker red 
 If they are pedunculated, they are attached by a thin stalk (pedicle). If
they are sessile, they are connected by a flat base to the uterine wall.
 Pedunculated polyps are more common than sessile ones.
ENDOMETRIAL POLYPS
 DIFFERENTIAL DIAGNOSIS
 Endometrial hyperplasia
– diffuse process, majority of fragments in curettage,
absence of thick walled vessels
 polypoid endometrial carcinoma

– malignant epithelial cells

 Adenofibroma

 Adenosarcoma

– stromal cells cytologically atypical and mitotically active

– stromal cells packed tightly around non malignant glands
– leaf like pattern
 TREATMENT
 Medication: This includes progestin or gonadotropin-
releasing hormone agonists, as they help to regulate
hormone balance. However, they are only a temporary
measure, as symptoms often return when stopped.
 Polyps can be surgically removed using curettage with
or without hysteroscopy.[
 If it is a large polyp, it can be cut into sections before
each section is removed.[6] 
 If cancerous cells are discovered,
hysterectomy (surgical removal of the uterus) may be
performed.
 Whichever method is used, polyps are usually treated
under general anesthetic
 PROGNOSIS
 Endometrial polyps are usually benign although some
may be precancerous or cancerous
 About 0.5% of endometrial polyps contain
adenocarcinoma cells.
 less than one percent of uterine polyps turn out to be
malignant.
 Polyps can increase the risk of miscarriage in women
undergoing IVF treatment.
 If they develop near the fallopian tubes they may lead to
difficulty in becoming pregnant.
 recurrence of endometrial polyps is frequent.

 Untreated, small polyps may regress on their own.

 PREVENTION OF ENDOMETRIAL POLYPS
 Unfortunately, there is no way to prevent uterine
polyps,
 but you can do your best to catch them before they
become a problem.
 It is recommended to have regular gynecological
checkups
 reduce risk factors such as obesity and high blood
pressure.