What Are Uterine Polyps

Throughout this article, we will explore what uterine polyps are, the underlying causes, symptoms, diagnosis and treatment techniques available to ensure that you are well-informed about this particular medical condition and gain valuable insight to aid you in making well-informed decisions regarding your own care or the care of your loved ones.

Uterine polyps are small, benign growths that grow and develop on the inner lining of the uterus, otherwise known as the endometrium. These polyps are typically small in size; however, this can vary. They are composed of tissue and are usually generally harmless, although they can cause symptoms such as pelvic pain and uterine bleeding. In particularly rare cases, uterine polyps can be surgically removed if they cause discomfort or interfere with fertility. Early detection and regular check-ups with a healthcare professional are key in managing uterine polyps and preventing any further potential complications. 

Read on to learn more about the symptoms, causes, diagnosis, and treatment methods available for uterine polyps to provide you with the knowledge needed to make informed decisions regarding your care. 

Introduction

A uterine polyp is an abnormal growth from the lining of the uterus, otherwise known as the endometrium. These tissue-like growths are usually benign and can vary significantly in size.1 These abnormal growths can result in a variety of symptoms, such as pelvic pain and uterine bleeding.2 An understanding of uterine polyps is essential in enabling individuals to recognise any potential health concerns, as well as when to seek appropriate medical care and make informed decisions regarding their reproductive well-being. 

What are uterine polyps?

Definition and description

Uterine polyps can be defined as small, benign growths that occur on the inner lining of the uterus. These uterine polyps are composed of tissues, including glandular cells and blood vessels, which can vary significantly in shape and size (ranging from 5 mm to as large as filling the whole uterine cavity).¹ Uterine polyps are usually attached to the uterine lining by a thin base or stalk. Whilst these abnormal growths are usually benign, they can result in symptoms such as discomfort, pelvic pain and abnormal bleeding between periods.²

Types of uterine polyps

There are two main types of uterine polyps: cervical polyps and endometrial polyps. Endometrial polyps are the most common type of uterine polyps and form on the inner lining of the uterus. These particular polyps are typically composed of glandular tissue and can significantly vary in size.¹ In comparison, cervical polyps develop in the lower part of the uterus that extends into the vagina, otherwise known as the cervical canal.³ Both types of polyps are typically non-cancerous and can be diagnosed and treated in different distinct ways. Understanding the different types of polyps is essential to help you make informed decisions regarding your own management and treatment decisions. 

Symptoms and signs

Common symptoms

Most commonly, women who have uterine polyps may show no symptoms at all. However, there are a range of common symptoms, such as abnormal vaginal discharge, excessively heavy menstrual periods, vaginal bleeding after menopause, bleeding between menstrual periods as well as irregular menstrual bleeding.⁴ In addition, some individuals may experience pelvic pressure or pain, especially during menstruation. In rare cases, uterine polyps can also result in recurrent miscarriages or fertility issues.⁵ 

How symptoms vary with location (endometrial vs. cervical)

Symptoms of uterine polyps can vary significantly depending on their location within the uterus (whether they are cervical or endometrial). Endometrial polyps, which are found in the inner lining of the uterus, typically display symptoms of abnormal uterine bleeding, which can manifest as heavy menstrual bleeding, bleeding between periods or irregular periods. In comparison, cervical polyps, which are situated in the cervix, typically present with symptoms such as vaginal bleeding after menopause, after intercourse or between periods. Whilst the symptoms of both types of polyps are similar, identifying and detecting the location can aid healthcare professionals in diagnosing and treating this condition effectively.

Causes of uterine polyps

Hormonal factors

Whilst the exact cause of uterine polyps is unknown, there are several proposed theories. One main theory of the cause of uterine polyps is hormonal factors. An imbalance of hormones, in particular elevated levels of progesterone and oestrogen, have been known to contribute to the formation and development of uterine polyps. Oestrogen plays a key role in stimulating the growth of the uterine lining, whereas progesterone plays a key role in regulating this growth.¹ 

Age-related factors

Age-related factors have been shown to play a key role in the development of uterine polyps. Whilst uterine polyps can be found in all age groups, they are most commonly found in individuals between the ages of 40 and 50, as well as postmenopausal women.¹ It is believed that the hormonal changes associated with this stage of life, especially the imbalance of progesterone and oestrogen levels, contribute to the formation of uterine polyps. It is also suggested that as women age, the progressive exposure of the lining of the uterus to oestrogen may result in an increased likelihood of polyp formation.⁶ However, uterine polyps can be found in women of all ages, therefore age-related factors are just one example of one potential cause of the development of uterine polyps. 

Chronic inflammation

An additional potential cause of uterine polyps is chronic inflammation; it has been suggested that the inflammatory process within the lining of the uterus can result in the gradual formation of uterine polyps. Whilst the exact mechanism is not yet fully understood, it has been suggested that ongoing irritation, inflammation or injury can result in abnormal growth.¹ A range of factors including long-term exposure to irritants, infections and repeated trauma may result in this inflammatory response. Additionally, particular medical conditions such as chronic endometritis, in which the lining of the uterus is constantly inflamed, have been associated with an increased risk of developing polyps.⁷ Chronic inflammation is just one of the suggested causes of uterine polyps, a comprehensive evaluation with a trained healthcare professional is needed to determine the underlying causes in individuals cases of uterine polyps.  

Genetics

Whilst the exact cause of uterine polyps is not fully known, there is evidence to suggest that genetics may play a role in the development of uterine polyps. Studies have highlighted that women with a family history of uterine polyps have an increased risk of developing uterine polyps themselves.⁸ Despite this, genetics alone are very unlikely to be the only cause, as it is suggested that other factors, such as chronic inflammation and hormonal imbalances, are also thought to be involved in the development of uterine polyps. Therefore, it is suggested that a combination of genetics as well as environmental factors result in the development of uterine polyps.

Diagnosis of uterine polyps

Medical history and physical examination

Typically, the diagnosis of uterine polyps begins with a thorough medical history assessment as well as a physical examination. Throughout the medical history assessment, a trained healthcare professional will ask questions regarding the patient's menstrual history, as well as any associated symptoms such as pelvic pressure or pain and heavy menstrual bleeding. It is vital to state any particular medications or medical conditions that may have an impact on the reproductive system during this medical history assessment. During the physical examination, the healthcare professional may detect uterine polyps by feeling for any irregularities in the size or shape of the uterus.⁸ These assessments help to provide valuable information; however, they are usually only the starting point and are followed by additional diagnostic tests such as imaging techniques, ultrasounds and biopsies. 

Imaging techniques

A key part of the diagnostic process for uterine polyps involves various imaging techniques, such as transvaginal ultrasounds and a hysteroscopy. A transvaginal ultrasound is a non-invasive procedure in which a probe is inserted into the vagina to generate images of the uterus. These ultrasounds can help identify the location, size, and presence of any potential uterine polyps.⁹ 

Additionally, for a more definitive diagnosis, a hysteroscopy may also be recommended. A hysteroscopy is a minimally invasive procedure in which a thin tube with a camera is inserted through the cervix and into the uterus. This allows healthcare providers to have a direct view of the uterine cavity and confirm the presence of any uterine polyps. Additionally, polyp removal or biopsies can also be performed during this procedure.¹⁰ These particular imaging techniques, alongside a thorough medical history and physical examinations, help to ensure accurate diagnosis as well as aid in effective treatment strategies. 

Biopsy and histopathology

In the process of diagnosing uterine polyps, conducting a histopathological examination through obtaining a biopsy is a very important step. During a procedure such as a hysteroscopy, a sample of the suspected polyp is collected and sent to a laboratory for histopathological analysis. During this analysis, the sample is examined under a microscope to determine its structure and cellular composition. Additionally microscopic examination also helps to rule out whether the polyps are benign or cancerous.¹¹ The results from histopathological examination can aid healthcare professionals in creating an effective treatment plan on an individual basis for individuals affected by uterine polyps. 

Treatment options

Observation and monitoring

The various treatment options for uterine polyps depend on factors such as symptoms, location, and size of the polyps. In circumstances where polyps are asymptomatic, small and not causing any fertility issues, observation and monitoring are usually recommended. During this approach, a trained healthcare professional may choose to monitor the polyps through imaging studies and regular appointments. If the polyp does not cause any significant symptoms and remains the same size, no further treatment may be required.¹ Despite this, ongoing monitoring is crucial to ensure that any worsening of symptoms or changes in the polyps are addressed and the patient’s treatment plan is adjusted if need be. 

Medications

An additional treatment option for uterine polyps involves the use of medications, particularly for individuals who wish to avoid surgery. Treatment for uterine polyps typically involves hormonal medications such as contraceptives to help regulate the menstrual cycle as well as potentially prevent or shrink the growth of the uterine polyps. Additionally, these particular medications can help to alleviate symptoms caused by uterine polyps, such as abnormal bleeding.¹² Medications as a treatment option for uterine polyps are usually only considered in cases where the polyps are small and are not causing significant discomfort, as well as being an important option for patients who wish to avoid surgery.

Surgical removal

The main treatment option for uterine polyps is typically surgical removal, particularly when they cause significant discomfort or fertility issues. The primary surgical procedure used for the removal of uterine polyps is a hysteroscopic polypectomy in which a thin tube with a camera is inserted into the uterus to detect and remove the polyps. In particularly rare cases, another procedure known as a hysterectomy may be recommended, especially if there are numerous large polyps which are cancerous.¹³ Surgical removal not only helps to alleviate any symptoms caused by uterine polyps but also allows for examination of the polyp to rule out any malignancy. 

Summary

To summarise, uterine polyps are abnormal growths within the inner lining of the uterus, otherwise known as the endometrium. The key symptoms of uterine polyps involve pelvic pressure and pain, abnormal uterine bleeding as well as fertility issues or recurrent miscarriages. Whilst the exact cause of uterine polyps is not known, it has been suggested that genetics, age-related factors, chronic inflammation and hormonal imbalances are associated with an increased risk of developing uterine polyps. The diagnostic process for uterine polyps typically involves a comprehensive medical history assessment and physical examination; this is then followed by imaging techniques (such as hysteroscopy and ultrasound) as well as biopsies to further confirm the presence of uterine polyps. Early identification and detection of uterine polyps are crucial to help alleviate symptoms, address potential concerns regarding fertility and ensure effective treatment. If you are experiencing any of the aforementioned symptoms it is advised that you consult with a trained healthcare professional to address any of your potential concerns.