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Endometrial polyp: abnormal bleeding is the main symptom
Endometrial polyps are one of the most frequent causes of abnormal bleeding in both pre- and post-menopausal. However, most endometrial polyps may remain without any other symptoms, being found in ultrasound examinations performed for other causes. They constitute an abnormal growth of the endometrial glands and the stroma, forming a projection (a polyp) on the inner surface of the uterus.
Most endometrial polyps are benign but malignancy may occur in some women, so the diagnosis
In addition to the gynecological examination, transvaginal ultrasonography is the main method of evaluation, since it allows assessment of the uterine cavity, but also the fallopian tubes, ovaries and pelvic region as a whole. molecular mechanisms have been proposed as having a role in the development of endometrial polyps, especially rearrangements in high-mobility group (HMG) genes that express transcription factors.
Endometrial polyps are rare among adolescents and their accurate prevalence is difficult to establish since most of them remain without producing symptoms. On the other hand, in women with abnormal genital bleeding who undergo biopsy or removal of the uterus (hysterectomy), the prevalence of polyps varies between 10 and 24% of the cases.
Known risk factors are obesity, the use of estrogen for hormone replacement and the use of tamoxifen for the treatment or prevention of breast cancer. Endometrial polyps develop in 2 to 36% of women receiving tamoxifen.
Endometrial polyps are typically identified in association with abnormal uterine bleeding or in cases of infertility investigation. Abnormal uterine bleeding occurs in 64-88% of women with endometrial polyps, and women with abnormal genital bleeding must necessarily be screened for endometrial cancer.
In addition to gynecological examination, transvaginal ultrasonography is the primary method for evaluation since it allows to evaluate not only the uterine cavity, but also the fallopian tubes, ovaries and pelvic region as a whole.
In cases in which the examination shows suspicion of malignancy the hysteroscopy with biopsy is fundamental and will allow the diagnosis for sure. Approximately 95% of endometrial polyps are benign. As it has been said, some polyps may represent only endometrial hyperplasia or pedunculated fibroids with intrauterine growth.
Endometrial polyps that cause symptoms should be removed in all patients. Simple hysteroscopy with biopsy of the polyp most of the time is already the treatment itself. However, if there is a diagnosis of malignancy, removal of the uterus is the most appropriate procedure.
In summary, the finding of an endometrial polyp is not a serious finding, since 95% of the time it is benign. However, there is a potential for malignancy, especially if associated with vaginal bleeding, most of them may require evaluation by hysteroscopy and biopsy.
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