Uterine polyps are localised excessive growths from uterine lining. They usually contain fibrous tissue and a feeding vessel. They are the common cause of abnormal uterine bleeding, such as heavy periods, bleeding in between periods and in few cases excessive discharge from vagina as well as postcoital bleeding. The incidence of polyps in a premenopausal woman is around 10-40% and symptoms do not correlate with polyp number.
More the number of polyps, higher the risk of pre-malignant and malignant transformation. Majority of polyps are asymptomatic. Polyp diameter more than one centimeter, menopausal status and presenting with abnormal bleeding increases the risk of pre-malignant and malignant tissue changes. Removal of polyp appears to have a favorable outcome in infertile women. One in three women with subfertility problems have polyps.
Uterine polyps are commonly associated with Tamoxifen use. On breast tissue, tamoxifen suppresses oestrogen receptor activity and on uterus, it stimulates the endometrium.
Women using Tamoxifen are at specific risk for development of polyps and the prevalence being 30-60%. About 3% of Tamoxifen related polyps are known for malignant transformation. 10% of polyps can show carcinomatous change.
A progestogen with high antioestrogenic as well as use of oral contraceptive pills may have a protective effect.
Once polyps are identified, patients are generally advised them to excised. With the introduction of hysteroscopic morcellators such as Truclear, patients will be told that, in majority of cases they need to be removed.
The removal can be accomplished by,
- Traditional monopolar resectoscope. Here the main challenge is retrieval of tissue and it can cause serious complications.
- The more safer option is to use , bipolar resectoscope. With this retrieval still remains a challenge.
- The latest development is to use, hysteroscopic morcellator which can be cut and retrieved at the same time. With the use of this technology patient can be treated as awake and one can go home straight after the procedure.
- It is important that, the base of the polyp has been completely excised as some studies have shown that the pre-malignant and malignant change can invariably happen at the root of the polyp