Uterine polyp: Definition, symptoms, and medical treatments

What is a uterine polyp? Does it hurt ? Is it dangerous? So many questions we can ask ourselves when we are diagnosed with this type of lump. Although they should not be taken lightly, polyps are generally benign. Professor Gautier Chene explains the phenomenon to us.

Definition and location of the uterine polyp

A uterine polyp is a round or oval-shaped growth developing inside the uterus . It can develop in the lining of the endometrium, or the cervix. There can be several at once, but the uterine polyp is generally alone, and its size varies from a few millimeters to five or six centimeters for the largest.

In fact, polyps always develop within a mucous membrane, which is why they can be found in other areas of the body such as the bladder, vagina, stomach, etc.

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The uterine polyp, a benign tumor

The uterine polyp is a benign tumor, which can be single or multiple, of variable size and develops from the uterine lining or endometrium . It can be located at the level of the cervix (endocervix polyp) or in the uterine cavity (intracavitary polyp). Sometimes, it can exteriorize at the external orifice of the cervix, we then speak of a polyp delivered through the cervix.

The uterine polyp is generally connected to the uterine wall by a sort of "foot" (pedunculated polyp) or a wider base (sessile polyp). Its presence can cause variations in the menstrual cycle , and in rare cases, it can become cancerous.

Do not confuse uterine polyp and fibroid:

It is sometimes confused with another growth that can appear in the uterus: the fibroid. The polyp differs from the fibroma, among other things, by its lower incidence : it is generally smaller and cannot deform the uterus. Unlike fibroids, it is generally not painful since it is soft.

Uterine polyps are caused by a high level of estrogen, responsible for the growth of the endometrium , they can sometimes “boost” it so much that they then cause the appearance of an excrescence. Gautier Chene, professor of gynecological surgery, explains:

“Generally in gynecology there are many problems linked to hyperestrogenism . It is not by taking a blood test that we will realize this: we can have a normal level of estrogen but higher in relation to the level of progesterone. It is very common before menopause, so nine times out of ten it is benign, on the other hand in postmenopausal women it is necessary to worry and suspect a cancer problem . Because at menopause, there is much less hormonal secretion.”

Any polyp diagnosed at menopause must be removed, since cancers are more likely to appear after fifty.

Symptoms related to uterine polyp

Uterine polyps can be asymptomatic , but they can in any case be detected during a routine gynecological examination or ultrasound.

Symptoms of a uterine polyp can vary depending on its size and location . The majority of affected women, however, do not present any specific symptoms, often making the detection of polyps difficult.

However, certain signs can alert you. Among them, we find:

• Abnormal vaginal bleeding , such as breakthrough bleeding (bleeding outside of periods) or menorrhagia (heavier periods than usual). This bleeding can be irregular and unpredictable.
• Abdominal or pelvic pain , which is however quite rare.
• Vaginal discharge that can sometimes look like pus, especially if the polyp is infected.

It should be noted that the presence of uterine polyps can also make pregnancy more difficult to achieve, although this is a rather rare case.

If any of these symptoms appear, the ideal is to consult a gynecologist to check the presence or absence of a polyp. A hysteroscopy examination (insertion of a tube fitted with an optical device) will determine the size and location of the polyp, and the method to adopt to remove it.

Uterine polyp and vaginal bleeding

Vaginal bleeding can sometimes be a sign of the presence of a uterine polyp. Indeed, the abnormal growth of tissue in the uterus can cause bleeding outside of periods or after sexual intercourse.

These bleedings can be varied:

• spotting (small losses of blood between periods )
• periods heavier than usual
• or bleeding after menopause.

In the event of abnormal vaginal bleeding, it is recommended to consult a gynecologist to determine the cause and consider possible treatment.

It should be noted that not all uterine polyps cause bleeding and not all vaginal bleeding is necessarily due to a polyp . Other causes can be the origin of this bleeding, such as uterine fibroids.

In case of a uterine polyp, treatment will depend on several factors, such as the size of the polyp, symptoms, the patient's age and her desire to become mothers. In the absence of symptoms, simple monitoring can sometimes be sufficient . In the event of significant bleeding or the desire to become pregnant, removal of the polyp may be considered.

The link between uterine polyp and menopause

During menopause, hormonal changes can promote the appearance of uterine polyps. This is because estrogen production decreases, affecting the menstrual cycle and the uterine lining. This can cause abnormal growth of endometrial cells, leading to the formation of polyps.

Thus, uterine polyps are frequently diagnosed in postmenopausal women. However, their presence is not systematically associated with symptoms. They can be detected during a routine gynecological exam.

Additionally, uterine polyps can be a cause of vaginal bleeding after menopause. If you notice bleeding outside of your period or after sexual intercourse, it is recommended to consult a healthcare professional.

Finally, it is essential to clarify that despite the frequency of uterine polyps in postmenopausal women, the majority of these tumors are benign.

Uterine polyp during pregnancy

During pregnancy, the presence of a uterine polyp can have variable repercussions depending on its size and location. A small polyp of less than 12mm generally does not affect fertility and does not hinder the progress of the pregnancy. However, a larger or poorly positioned polyp can hinder the transport of sperm , hinder implantation of the embryo or even cause a miscarriage.

Monitoring these polyps is therefore essential during pregnancy. If symptoms such as bleeding or pain occur, intervention may be considered. This is generally done using pelvic ultrasound and may consist of removal of the polyp.

It should be noted that despite their potential impact on pregnancy, the majority of uterine polyps remain benign.

Uterine polyp: a risk of cancer?

Although the majority of uterine polyps are benign, in rare cases they can pose a risk of malignant degeneration. The risk of cancer associated with uterine polyps is generally low, estimated between 1.5 and 5% of cases. However, this risk can vary depending on factors such as the patient's age and medical history . In the presence of uterine polyps, regular medical monitoring is recommended in order to quickly detect any possible malignant development.

In the case of a suspicious polyp , a histological analysis is carried out following its removal to confirm or refute the presence of cancer cells. This approach aims to eliminate any risk of uterine cancer.

It is also important to emphasize that the size of the polyp can influence the risk of cancerization . Indeed, the larger the polyp, the higher the risk of cancer.

Detection by ultrasound and hysteroscopy

Ultrasound and hysteroscopy are essential diagnostic tools for the detection of uterine polyps. Transvaginal ultrasound, performed by the gynecologist, is a non-invasive method using sound waves to create images of the uterus. It thus makes it possible to detect possible polyps.

Hysteroscopy, on the other hand, is considered the “gold standard” method for diagnosing uterine polyps . This technique offers direct visualization of the uterine cavity thanks to the introduction of a hysteroscope (a tube fitted with a small camera) through the natural channels. This way, the doctor can precisely observe the size, volume and location of the polyp, and possibly take a sample.

Possible causes of a uterine polyp

The exact causes of uterine polyp formation remain unclear. However, several risk factors have been identified.

• Hormonal imbalance: An imbalance between the female sex hormones, progesterone and estrogen, seems to contribute to their appearance. An overproduction of estrogens, particularly during menopause or following hormonal treatment, can promote their development.

• Risk factors: Age, obesity, high blood pressure, diabetes are also risk factors. Polyps are more common in women going through menopause.

• Chronic inflammation or infection: Chronic inflammation or infections of the uterus can also cause the formation of uterine polyps.

It is essential to clarify that these risk factors can promote the appearance of polyps, but their presence is not systematically associated with the formation of these tumors.

Treatment of uterine polyp: when should you operate?

Operation to remove a uterine polyp is not always necessary. It is generally considered in the following cases:

• Micro-polyps : For small polyps, less than 5 millimeters, surgical intervention is not systematic.
• Bleeding : An intervention may be necessary when the woman has bleeding outside of her period.
• Infertility : In case of fertility problems, removal of the polyp can improve the chances of conception.
• Risk of malignancy : Although rare, if a risk of malignancy is suspected, removal of the polyp is recommended.

It should be noted that each case is unique and the decision to operate must be made based on the symptoms and context of each patient.

Removal of the polyp: a necessary operation?

To meet the need to treat a uterine polyp, ablation is an option to consider. You should know that the uterine polyp removal procedure is normally scheduled after the cessation of menstrual bleeding and before the start of ovulation.

However, not all polyps require intervention. Indeed, when the polyps are small, the tendency is more towards observation. This is particularly the case for cervical polyps , which are growths in the mucous membrane that lines the cervix and which are never cancerous.

For polyps that cause vaginal bleeding or discharge, they are removed during the pelvic exam in the doctor's office. Generally, the procedure is not painful and no anesthetic is needed.

It is also important to mention that the removal of the polyp is systematically followed by an analysis so as not to overlook hyperplasia or cancer.