I call them pesky polyps because that’s just what they are … pesky! Polyps can happen in many different places in the body, but the ones we worry about in fertility are uterine polyps. These pesky polyps decrease pregnancy rates and have a habit of coming back even after removal.
It’s not the same polyp growing over and over; it’s that sometimes a patient has a propensity to have polyps. The good news is that Dr. Wells and I are good at catching them and even better at safely removing them.
What are polyps anyway?
Uterine polyps are localized, hyperplastic overgrowth of endometrial glands and stroma around a vascular core. This overgrowth forms either a sessile (or flat) polyp or a pedunculated (or projecting) polyp from the lining of the uterus.
Sometimes these growths also have smooth muscle present. Polyps can be single in number, but multiple polyps can also occur. They range in size from a few millimeters to several centimeters and they can occur anywhere in the uterine cavity.
Why do polyps occur?
We don’t know for sure, but we have some theories. These include:
• Endometrial hyperplasia (abnormal growth of the uterine lining)
• Overexpression of an enzyme found in the lining of the uterus called aromatase
• Possible genetic factors that explain the propensity to produce these pesky polyps.
Who might be at risk for getting polyps?
Polyps can be symptomatic or asymptomatic, so we don’t have a truthful answer to this question. Among clinically recognized polyps we know that they occur more frequently with increasing age in premenopausal women. Because the polyps display estradiol receptors it makes sense that increased levels of estradiol may also increase one’s risk, however a direct relationship in patients has not been proven. This is important since most infertility patients are exposed to superphysiologic levels of estradiol even if it is for a short time.
Likewise, women with a body mass index greater than 30, have more adipose tissue, or fat cells, which can increase circulating estradiol levels and are more likely to develop polyps.
What are the Symptoms of Polyps in the Uterus?
If you have a symptomatic polyp you will most likely experience abnormal uterine bleeding. This can vary from heavier than normal menstrual cycles to periods that last too long to having bleeding when you are not on your period at all. Many women report post-coital bleeding, or bleeding after intercourse. Rarely, large polyps can prolapse through the cervical canal and even be visualized on pelvic exam. Despite this, it is estimated that more than half of women with polyps are likely to have NO symptoms.
If most women don’t have symptoms, how do you catch polyps?
Most of the time Dr. Wells and I catch polyps on ultrasound. They are most likely to be visible in the late follicular phase when the normal lining of the uterus is darkest on ultrasound and the polyp will appear bright white because of its vascular core. Sometimes the flat polyps are harder to catch so we elect to perform a saline sonogram. This is a special ultrasound where sterile salt water is infused into the uterus, so the contour of the uterine lining can clearly be seen. While technically challenging, the saline sonogram is not painful to most patients and can be performed in the office without sedation.
Do Polyps in the Uterus Need to be Removed?
In an observational study of over 10,000 women, more than 95% of polyps were benign. Occasionally we do find polyps that can contain malignancy, but this is extremely rare in the fertility population. Polyps in post-menopausal women or obese women who have other problems with their uterine lining may be at increased risk. When a polyp is removed, we always send this tissue to pathology for careful evaluation. In fertility, the reported prevalence in those undergoing in vitro fertilization is 6-8%.
A systematic review concluded that removing polyps was beneficial in infertile women. This conclusion was based primarily on a randomized trial that showed a higher pregnancy rate in women who underwent uterine polyps treatment (removal) compared with hysteroscopy alone (63 versus 28%!). The good news is that endometrial polyps do not appear to be associated with an increased risk of miscarriage or adverse obstetric outcomes.
What does a polypectomy entail?
A polyp is removed through a hysteroscope, or a camera that is placed through the cervix into the uterus. Even though this is a surgery, that mean NO incisions! You would receive anesthesia to keep you comfortable, so you will be asleep for the whole procedure. The camera is advanced, and the entire uterus is evaluated. The polyp is captured with tiny graspers and usually peels out of the lining with ease. If there are numerous polyps often a curettage is required to remove them all.
Is it Painful to have Polyps Removed?
You may have increased cramping, vaginal bleeding or gas-like feelings for a day or two after the procedure. Most of our patients feel much better within the first few days following the procedure, but it’s best not to lift heavy objects within the first couple of weeks.
How Long Does it Take to Recover From Uterine Polyp Removal?
If you’re wondering what to expect after uterine polyp removal, the entire procedure usually only takes about an hour and is outpatient, so you go home the same day. Many patients worry about uterine polyp removal recovery time, but recovery is quick; after a single polypectomy, patients can return to work the next day and expect a full recovery within two weeks.
In summary, polyps are pesky. They are important to get rid of, but nothing the team at Audubon Fertility can’t handle.