WHAT IS AN ENDOMETRIAL POLYP?

“ I had prolonged menstrual spotting after my menses. It is very inconvenience though I do not have symptoms of giddiness. I consulted my doctor and was suspected to have a uterine polyp.  I had a hysteroscopy and polypectomy done. My symptoms resolved.”

Endometrial polyps are small, soft growths on the endometrium (womb lining).  It irritates the surrounding tissue and cause spotting or vaginal bleeding. They are generally benign growth.  The exact cause of endometrial polyps is not known.  They form when there is an overgrowth of endometrial tissue.

Clinical presentation

Generally, the endometrial polyps are often “silent” or asymptomatic.  They are discovered when women are investigated for irregular menstrual bleeding, prolonged menstrual spotting, heavy menstrual loss or during work-up for infertility.  Some of the risk factors that increase the possibility of developing endometrial polyps include obesity and use of tamoxifen, a drug therapy for breast cancer.

Diagnosis

The diagnosis of endometrial polyps can be made during a clinical examination.  Some polyps protrude through the cervix and can be easily seen on pelvic speculum examination at the clinic. A gynecology transvaginal scan may indicate a polyp when the endometrium is thick or presence of a echogenic mass in the uterine cavity.  Other methods include a hysterosalpingogram (HSG) and a hysteroscopy.  The HSG uses a contrast dye injected into the uterus to delineate the uterine cavity.  A polyp will be easily seen following the dye injection.

A hysteroscopy involves the use of a mini telescope, inserted into the uterine cavity via the cervical opening.  It allows a thorough inspection of the cavity, diagnosis and removal of polyp (polypectomy) for confirmation.

Treatment option for endometrial polyps

  1. Watch and wait approach. This may be consider if the polyps are small and not causing symptoms.
  2. Medication. The progesterone hormone can be used to shrink the polyps and lessen symptoms.  The recurrence is high once the medication is stopped.
  3. Surgical removal. Most endometrial polyps are removed via a hysteroscopy at the day care surgery.  A hysterectomy is rarely indicated unless malignancy is a concern.

 

Reference

  1. De Vries LD et al., J Clin Ultrasound 2000
  2. De Waay et al., Obstet Gynecol 2002
  3. Clevenger-Hoeft M et al., Obstet Gynecol 1999
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Author: Dr Ng Soon Pheng

Dr. Ng Soon Pheng MD(USM), M.Med (O&G), Fellow Reprod Medicine (Singapore), AM (Mal) Dr. Ng Soon Pheng qualified from University Kebangsaan Malaysia (UKM), Malaysia. After obtaining his post graduate degree, Dr. Ng Soon Pheng continued his clinical fellowship training in the field of IVF in Singapore. He was also the recipient of Yayasan Sultan Iskandar (Johor) Scholarship for the fellowship stint. Dr. Ng Soon Pheng has more than 10 years of working experience in the field of Obstetrics and Gynaecology in the public and university hospital, with special interests in infertility. He was an Associate Professor with the Department of O&G in Universiti Kebangsaan Malaysia (UKM) specialising in infertility. Dr. Ng Soon Pheng is currently Consultant Obstetrician and Gynaecologist with special interests in infertility at Columbia Asia Hospital - Puchong.