{{Short description|Mass on the interior lining of the uterus}} {{Infobox medical condition (new) | name = Endometrial polyp | synonyms = Uterine polyp | image = Polyp.Uterus.jpg | caption = Endometrial polyp, viewed by sonography | pronounce = | field = Gynecology | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} An '''endometrial polyp''' or '''uterine polyp''' is a mass in the inner lining of the uterus.<ref name=WHOblue2020>{{cite book|title=Female genital tumours: WHO Classification of Tumours|chapter-url=https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/Female-Genital-Tumours-2020|year=2020|editor=WHO Classification of Tumours Editorial Board|publisher=International Agency for Research on Cancer|location=Lyon (France)|edition=5th|volume=4|isbn=978-92-832-4504-9|chapter=6. Tumours of the uterine corpus: Endometrial polyp|page=268}}</ref> They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).<ref name=PGU> {{cite book |author=Jane A. Bates |title=Practical Gynaecological Ultrasound |publisher=Cambridge University Press |location=Cambridge, UK |year=1997 |isbn=1-900151-51-0 }}</ref><ref name="Mayo"> {{cite web | title =Uterine polyps | publisher =MayoClinic.com | date =2006-04-27 | url =http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1}}</ref> Pedunculated polyps are more common than sessile ones.<ref name="SDS">{{cite book | last =Sternberg | first =Stephen S. |author2=Stacey E. Mills |author3=Darryl Carter | title =Sternberg's Diagnostic Surgical Pathology | publisher =Lippincott Williams & Wilkins | year =2004 | url =https://books.google.com/books?id=ko3Hew4xaj4C | isbn =0-7817-4051-7 | page =2460 }}</ref> They range in size from a few millimeters to several centimeters.<ref name="Mayo" /> If pedunculated, they can protrude through the cervix into the vagina.<ref name="PGU" /><ref name="Merck">{{MerckManual|18|244|d||Dysmenorrhea: Menstrual abnormalities}} </ref> Small blood vessels may be present, particularly in large polyps.<ref name="PGU" />
==Signs and symptoms== thumb|Uterine polyps
They often cause no symptoms.<ref name="SDS" /> Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (menorrhagia), and vaginal bleeding after menopause.<ref name="Mayo" /><ref name="GPN">{{cite web | title =Endometrial Polyp | publisher =GPnotebook | url =http://www.gpnotebook.co.uk/simplepage.cfm?ID=1214971910 | access-date =2007-10-20 }}</ref> Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.<ref name="OGDT">{{cite book | last =DeCherney | first =Alan H. |author2=Lauren Nathan | title =Current Obstetric & Gynecologic Diagnosis & Treatment | publisher =McGraw-Hill Professional | year =2003 | url =https://books.google.com/books?id=9xD0inFiEIAC&pg=PA703 | isbn =0-8385-1401-4 | page =703 }}</ref> If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea) may result.<ref name="Merck" />
==Cause== No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating estrogen.<ref name="Mayo" /> Risk factors include obesity, high blood pressure and a history of cervical polyps.<ref name="Mayo" /> Taking tamoxifen or hormone replacement therapy can also increase the risk of uterine polyps.<ref name="Mayo" /><ref name="Dew">{{cite book | last =Edmonds | first =D. Keith |author2=Sir John Dewhurst | title =Dewhurst's Textbook of Obstetrics and Gynaecology | publisher =Blackwell Publishing | year =2006 | url =https://books.google.com/books?id=450c5k81lEgC | isbn =1-4051-5667-8 | page =637 }}</ref> The use of an intrauterine system containing levonorgestrel in women taking tamoxifen may reduce the incidence of polyps.<ref>{{cite journal |vauthors=Chan SS, Tam WH, Yeo W, etal |title=A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women |journal=BJOG |volume=114 |issue=12 |pages=1510–5 |year=2007 |pmid=17995495 |doi=10.1111/j.1471-0528.2007.01545.x |s2cid=21145823 |doi-access=free }} </ref>
==Diagnosis== [[File:Nucleated red blood cells - endometrial polyp - low mag.jpg|thumb|right|200px|Micrograph of an endometrial polyp. H&E stain.]] thumb|Myometrium (smooth muscle cells) versus endometrial stroma (more cellular) versus endometrial polyp stroma (more collagenous). H&E stain Endometrial polyps can be detected by vaginal ultrasound (sonohysterography), hysteroscopy and dilation and curettage.<ref name="Mayo" /> Detection by ultrasonography can be difficult, particularly when there is endometrial hyperplasia (excessive thickening of the endometrium).<ref name="PGU" /> Larger polyps may be missed by curettage.<ref name="BBC">{{cite web | last =Macnair | first =Trisha | title =Ask the doctor – Uterine polyps | publisher =BBC Health | url =https://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml | archive-url =https://web.archive.org/web/20060331032537/http://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml | archive-date =March 31, 2006 | access-date = 2007-10-21 }}</ref>
Endometrial polyps can be solitary or occur with others.<ref name="DSTTS">{{cite book | last =Bajo Arenas | first =José M. |author2=Asim Kurjak | title =Donald School Textbook Of Transvaginal Sonography | publisher =Taylor & Francis | year =2005 | url =https://books.google.com/books?id=N_QMGLWEgzgC&pg=PA503 | isbn =1-84214-331-X | page =502 }}</ref> They are round or oval and measure between a few millimeters and several centimeters in diameter.<ref name="OGDT" /><ref name="DSTTS" /> They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.<ref name="OGDT" /> The polyps consist of dense, fibrous tissue (stroma), blood vessels and glandlike spaces lined with endometrial epithelium.<ref name="OGDT" /> 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.<ref name="DSTTS" /> Pedunculated polyps are more common than sessile ones.<ref name="SDS" />
==Treatment== Polyps can be surgically removed using curettage with or without hysteroscopy.<ref name="UCSF">{{cite web |title = Uterine bleeding – Signs and Symptoms |publisher = UCSF Medical Center |date = 2007-05-08 |url = http://www.ucsfhealth.org/adult/medical_services/womens_health/gynecology/conditions/ubleed/signs.html |access-date = 2007-10-20 |archive-url = https://web.archive.org/web/20080411022146/http://www.ucsfhealth.org/adult/medical_services/womens_health/gynecology/conditions/ubleed/signs.html |archive-date = 2008-04-11 }}</ref> When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping forceps at the beginning of the curettage procedure.<ref name="OGDT" /> Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through the cervix. Large polyps can be cut into sections before each section is removed.<ref name="OGDT" /> The presence of cancerous cells may suggest a hysterectomy (surgical removal of the uterus).<ref name="Mayo" /> A hysterectomy is usually not considered when cancer is not present.<ref name="OGDT" /> In either procedure, general anesthetic is typically supplied.<ref name="BBC" />
The effects of polyp removal on fertility has not been studied.<ref>{{cite journal|last1=Jayaprakasan|first1=K|last2=Polanski|first2=L|last3=Sahu|first3=B|last4=Thornton|first4=JG|last5=Raine-Fenning|first5=N|title=Surgical intervention versus expectant management for endometrial polyps in subfertile women.|journal=The Cochrane Database of Systematic Reviews|date=Aug 30, 2014|volume=8|issue=8|article-number=CD009592|pmid=25172985|doi=10.1002/14651858.CD009592.pub2|pmc=6544777|url=http://eprints.nottingham.ac.uk/31823/1/Jayaprakasan_et_al-2014-The_Cochrane_library.pdf|access-date=November 4, 2018|archive-date=November 4, 2018|archive-url=https://web.archive.org/web/20181104211152/http://eprints.nottingham.ac.uk/31823/1/Jayaprakasan_et_al-2014-The_Cochrane_library.pdf}}</ref>
==Prognosis== Endometrial polyps are usually benign although some may be precancerous or cancerous.<ref name="Mayo" /> About 0.5% of endometrial polyps contain adenocarcinoma cells.<ref>{{cite book | last =Rubin | first =Raphael |author2=David S Strayer | title =Rubin's Pathology: Clinicopathologic Foundations of Medicine | year =2007 | location =Lippincott Williams & Wilkins | url = https://books.google.com/books?id=kD9VZ267wDEC&pg=RA3-PA805 | isbn = 978-0-7817-9516-6 | page =806}}</ref> Polyps can increase the risk of miscarriage in women undergoing IVF treatment.<ref name="Mayo" /> If they develop near the fallopian tubes, they may lead to difficulty in becoming pregnant.<ref name="Mayo" /> Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.<ref name="OGDT" /> Untreated, small polyps may regress on their own.<ref>{{cite web | last = Kaunitz | first = Andrew M. | title = Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer? | work = Medscape Ob/Gyn & Women's Health | date = 2002-08-26 | url = http://www.medscape.com/viewarticle/440353 | access-date =2008-04-20 }}</ref>
==Epidemiology== Endometrial polyps usually occur in women in their 40s and 50s.<ref name="Mayo" /> Endometrial polyps occur in up to 10% of women.<ref name="PGU" /> It is estimated that they are present in 25% of women with abnormal vaginal bleeding.<ref name="Dew" />
==See also== *Cervical polyp *Uterine fibroids
==References== {{Reflist}}
== External links == {{Medical resources | DiseasesDB = | ICD10 = {{ICD10|N|84|0|n|80}} | ICD9 = {{ICD9|621}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }} {{Diseases of the pelvis, genitals and breasts}}
Category:Noninflammatory disorders of female genital tract