Uterine polyps

What are uterine polyps?

These are soft, red, fleshy tumours of the endometrium (the lining of the uterus or womb).

They vary in size from 1cm - when they contain only endometrial tissue - to 5cm. Larger polyps often contain not just endometrial cells, but also muscular and fibrous tissue from deeper in the wall of the womb.

Symptoms

Polyps are prone to bleeding. Often, the first clue to their existence is bleeding between periods.

Polyps may lie flat against the inside of the womb or be pedunculated, which means they form on the end of a 'stalk' of flesh.

Pedunculated polyps sometimes hang down through the cervix, where they may become trapped, cutting off the blood supply (known as strangulation). In this case they may bleed profusely and be painful.

Treatment and recovery

Surgery is usually recommended for polyps, for several reasons:

• To establish the diagnosis - this is usually done by curettage (scraping out the womb) and examining the tissue in a laboratory. Larger polyps may be missed. Other diagnostic techniques include hysteroscopy (where a thin telescopic device enables the surgeon to look inside the womb) or a hysterogram (a special X-ray of inside the womb).
• To rule out malignant cancer - most polyps are benign (they just grow larger where they are within the womb and don’t spread or invade other tissues), but it's essential that some of the tissue is removed (a biopsy) to make sure it's not malignant as occasionally endometrial carcinoma can form as a polyp.
• To cure irregular bleeding, by removing the polyp.
• To try to improve fertility. Polyps may interfere with implantation of a fertilised egg in the lining of the womb, so they're often removed in an attempt to raise the chances of conceiving.

While polyps can occasionally be biopsied under local anaesthetic, most surgeons recommend that they're examined and treated under general anaesthetic, especially if a curettage is to be performed as this procedure can be uncomfortable uncomfortable and the surgeon can make a more detailed examination under anaesthetic.

If you're worried about a general anaesthetic, ask whether the biopsy can be carried out under epidural. However, a general anaesthetic may be better especially as, with modern anaesthetic drugs, recovery is very swift.