Endometrial Polyps – Hysteroscopy

General information:

Endometrial polyps (EP) may arise in women of reproductive age but also during menopause. Around 9% of women with irregular vaginal bleeding have endometrial polyps [1].
A small proportion of EP may be carcinogenic. The rate of carcinogenic EP is 5.42% in post menopausal women and only 1.7% for women of reproductive age [2].
The presence of EP may cause embryo implantation failure.
EPs are formed due to abnormal growth of the cells that line the inside of the womb.

Endometrial polyps and assisted reproduction:

Women with EP that wish to follow an assisted reproduction technique (ART) need to have the EP removed before the start of the ART cycle.
If the EP is diagnosed during the ovulation induction whilst on an ART cycle it is possible to perform the oocyte retrieval followed by embryo cryopreservation. In this way the embryo transfer can be delayed for a later cycle, after the removal of the EP.
A study has shown that the pregnancy rate of IUI cycles was reduced in women with EP when compared to women that had the EP removed [3].

Causes of EP:

There is no clear cause for the development of EP. It seems that it is influenced by increased hormonal levels, especially estrogen.

Symptoms:

In some cases the presence of EP is not accompanied by any symptom. In other cases symptoms include:

  • Irregular menstrual bleeding
  • Excessively heavy menstrual bleeding
  • Vaginal bleeding after menopause

Diagnosis:

EP may be diagnosed by vaginal ultrasound. Its presence can be confirmed with the use of saline solution in the uterine cavity and modern ultrasound imaging (Sonohysterography).

Treatment:

EP is removed by hysteroscopy and curettage, which is the scraping of the EP from the uterine wall.

Hysteroscopy

Hysteroscopy is a safe, minimally invasive procedure with a low rate of complications [4].

With the aid of a hysteroscope, a very small camera is inserted in the uterus through the cervical opening, the polyps is located and removed.

It is a vaginal procedure with a mild general anaesthesia. Overnight hospital stay is not necessary and the woman can leave the hospital a few hours after the procedure. If the woman is trying to conceive then she can resume attempts after two cycles.

Following the removal of the polyps a histological exam is performed in order to determine its nature and exclude the possibility of it being benign.

1. Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA. 2000. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol. 21(2):180-183.

2. Lee SC, Kaunitz AM, Sanchez-Ramos L, Rhatigan RM. 2010 The oncogenic potential of endometrial polyps: a systematic review and meta-analysis. Obstet Gynecol. 116(5):1197-1205.

3. Pérez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, Engels V. 2005 Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod. 20(6):1632-1635.

4. Mettler L, Wendland EM, Patel P, Caballero R, Schollmeyer T. 2002 Hysteroscopy: an analysis of 2-years’ experience. JSLS. 6(3):195-197.

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