Endometrial (Uterine) Polyp: Watchful Waiting vs. Removal

Medically reviewed by Peter Weiss, MD

Endometrial polyps are abnormal growths that form within the uterine lining. These growths are also referred to as uterine polyps. Their exact cause is unknown, but it's thought that stimulation from the hormone estrogen plays a role.

Endometrial polyps are usually benign (not cancerous) and often cause no symptoms (are asymptomatic). The most common symptom they may cause is abnormal bleeding. In some instances, endometrial polyps may cause infertility.

Treatment for uterine polyps includes surgical removal, but this is not always necessary. This article will discuss treatment options for endometrial polyps and explain why treatment may be needed. It will also provide information about causes and risk factors.

Endometrial Polyp: A Mostly Benign Pathology Finding

Endometrial polyps form from an overgrowth of cells within the uterine lining. They contain glands, connective tissues, and blood vessels. Abnormal cell changes are often associated with malignancy, but the vast majority of endometrial polyps do not cause cancer.

The menopausal transition occurs when your periods stop permanently. Endometrial polyps are common after menopause and in people who have not yet gone through menopause. The malignancy rates are small in both groups but vary by menopausal status.

According to a 2019 review of 51 studies, 1.12% of endometrial polyps were diagnosed as cancerous in premenopausal people. Postmenopausal people had a higher malignancy rate of 4.93%. This review also found the risk of malignancy was greater in people of any age who were symptomatic rather than asymptomatic.    

If your healthcare provider suspects you have malignant polyps, they will recommend an endometrial biopsy. Biopsies surgically obtain samples of a polyp or endometrial tissue. The sample will be analyzed under a microscope by a pathologist. Pathologists are medical specialists who examine and analyze bodily tissues and fluids in a laboratory.

Factors That Influence Endometrial Polyp Removal

Factors that may indicate the need for endometrial polyp removal include:

• Age

• Weight

• Severity of symptoms

• Size of the polyp or polyps

• Medical history, including history of taking certain medications

Endometrial polyps can adversely affect your ability to get pregnant. They are also a potential cause of miscarriage. Your healthcare provider will recommend diagnostic testing if you're having trouble getting or staying pregnant. If uterine polyps are found, removal will most likely be recommended.

If you've gone through menopause and have one or more polyps of any size, your healthcare provider may recommend removing them if they cause abnormal bleeding. Your risk factors will also be taken into account.

Even though the risk is small, polyps can become cancerous. This may be more likely if you have certain risk factors, such as having taken Nolvadex (tamoxifen), a breast cancer drug.

Polyp Symptoms (and Absence of Symptoms)

Asymptomatic polyps sometimes shrink or resolve on their own without medical intervention. If you're premenopausal and have polyps that cause no symptoms, your healthcare provider may recommend ongoing testing and watchful waiting rather than removal. Watchful waiting provides a window of time during which the polyps can be assessed for changes that might require removal.

Infertility is a symptom of polyps. In premenopausal people, asymptomatic polyps don't require treatment unless they interfere with your ability to get or stay pregnant.

Around 50% of all cases of abnormal vaginal bleeding are attributed to uterine polyps. Abnormal bleeding may occur as:

• Bleeding or spotting between periods

• Very heavy periods

• Bleeding or spotting after menopause

• Breakthrough bleeding during hormonal therapy
  

Causes and Risk Factors

The reason why some people get endometrial polyps and others don't is not completely understood. The stimulating effects of estrogen, a hormone that regulates the female reproductive system, seem to play a strong role. The endometrial lining of the uterus contains an abundance of estrogen receptors. Fluctuations in estrogen levels may instigate polyp growth.

Factors such as age may influence your risk. Endometrial polyps are most common in people aged 40 to 49 and rare in those under 20. Perimenopause, the period leading up to menopause, often starts during the 40s, when estrogen levels are in flux.

Several risk factors are associated with an increase in estrogen and endometrial polyp formation. They include:

• Having obesity

• Taking tamoxifen

• Taking hormone replacement therapy (HRT) medications

• Having Lynch syndrome (an inherited condition that increases the risks of colorectal cancer and endometrial cancer)

• Having Cowden syndrome (a rare inherited condition that increases the risk of endometrial cancer)

How Are Endometrial Polyps Diagnosed?

Endometrial polyps are diagnosed through imaging tests and an endometrial biopsy, as follows:

• The type of imaging test most commonly used is transvaginal ultrasound. This noninvasive test uses a wand, inserted vaginally, to provide a view of the uterine cavity.
  

• Polyps may be diagnosed and treated during a hysteroscopy (also called hysteroscopic polypectomy). This test is slightly more invasive than an ultrasound. During this procedure, a thin, telescopic instrument will be placed into your vagina and inserted into the uterus through the cervix.

• Imaging tests are highly beneficial for identifying suspected polyps. However, the diagnosis can only be confirmed through a biopsy of removed endometrial tissue.
  

Treatment to Remove Endometrial Polyp(s)

In some instances, your healthcare provider may recommend a conservative, nonsurgical approach to treatment.

Medications such as gonadotropin-releasing hormone (GnRH) agonists or progestins, a synthetic form of progesterone, may be used to stop the production of estrogen. This shrinks the polyps temporarily, which will reduce or eliminate your symptoms. Once you stop taking the drugs, your polyps will likely revert to their original size.

Hysteroscopy (hysteroscopic polypectomy) is the surgery most commonly used to remove endometrial polyps. This minimally invasive procedure alleviates abnormal bleeding and may correct infertility. If cancer is suspected, a tissue sample will be extracted during this procedure to biopsy.

Hysteroscopic polypectomy is done vaginally. During this procedure, your cervix will be dilated. A thin, lighted scope called a hysteroscopic resectoscope will be inserted through your cervix into your uterus. An electrosurgical wire loop will be used to remove any polyps found.

Where Else Can You Get Polyps?

Polyps grow in areas of the body that contain mucous membranes. In addition to the uterus, polyps may form in these regions:

• Colon

• Rectum

• Bladder

• Throat

• Nose

• Ear canal
  

Healing and Side Effects From Removal

Endometrial polyp removal is an outpatient procedure that doesn't typically require sedation. Afterward, for several days, you may have vaginal spotting or bleeding, which can get heavy. This is to be expected. For a day or two, you may also feel gas pains, cramping, or abdominal pressure.

Side effects and complications can include:

• Bleeding, which can be heavy

• Infection

• Pain, such as shoulder or upper belly pain, caused by the gas used to expand the uterus during the procedure

• Pelvic inflammatory disease (PID)

• Uterine tearing or cervical damage, although these side effects are rare

A full recovery takes around two weeks. During this time, you may continue to see a watery or bloody discharge, which will continue to lessen until it stops.

Don't have vaginal sex or douche while you are healing. You should also refrain from lifting heavy objects or vigorous activities, such as running or contact sports.

Follow-Up and Ongoing Monitoring

After treatment, your healthcare provider may recommend ongoing monitoring through imaging tests and, possibly, endometrial biopsies. This helps ensure that changes to the endometrial lining, including those that might indicate cancer, are discovered in a timely manner.

Polyps can recur after surgical removal. Data indicates that postoperative recurrence rates for endometrial polyps have a wide range from 2.5% to 43.6%, There's some evidence that recurrence may be more likely when multiple polyps are removed.

If issues such as bleeding or infertility are resolved with treatment, you and your healthcare provider can assess how often you should be monitored and for how long.

Summary

Endometrial (uterine) polyps can cause symptoms or be asymptomatic. Your symptoms, age, and risk factors will all be considered when a treatment plan is designed. In some instances, watchful waiting accompanied by imaging tests will be recommended. In others, medication or surgical removal of the polyps will be recommended.

Read the original article on Verywell Health.