Endometrial polyp
Endometrial polyps are focal, usually benign, estrogen-sensitive overgrowths of endometrial glands and stroma projecting into the uterine cavity that present with abnormal or intermenstrual bleeding; diagnosis is by saline-infusion sonohysterography or hysteroscopy, and treatment is hysteroscopic polypectomy with pathology, which is both diagnostic and curative.
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What this article covers
- Overview
Focal endometrial overgrowth: an endometrial polyp is a localized, usually benign, hyperplastic projection of endometrial glands, stroma, and a vascular core protruding into the uterine cavity.
- Epidemiology
Common structural finding in AUB workups: endometrial polyps are a frequent structural cause identified when patients with abnormal uterine bleeding undergo hysteroscopy or saline-infused ultrasound.
- Risk factors
Unopposed or excess estrogen exposure: anovulatory cycles, PCOS, obesity, and estrogen-secreting ovarian tumors all raise focal endometrial estrogen stimulation.
- Pathophysiology
Focal glandular and stromal proliferation: a polyp forms from a localized overgrowth of endometrial glands and stroma organized around a central fibrovascular core, distinct from the diffuse proliferation of endometrial hyperplasia.
- Clinical features
Abnormal uterine bleeding is the dominant presentation: heavy menstrual bleeding, irregular or intermenstrual bleeding, or postmenopausal bleeding are the most common reasons a polyp is discovered.
- Differential diagnosis
Submucosal leiomyoma (uterine fibroid): also a structural PALM cause of heavy bleeding with an enlarged, irregular uterus on bimanual exam; differentiated by ultrasound or hysteroscopy showing a…
- Diagnosis
Confirmed by saline-infusion sonohysterography or hysteroscopy with histology: a polyp is identified as an intracavitary lesion outlined by instilled saline on sonohysterography or directly…
- Management
First, address active or heavy bleeding and anemia: obtain a CBC before starting either agent.
- Complications
Hyperplasia or carcinoma within the polyp: the principal serious complication, more likely with atypia on biopsy, postmenopausal status, or tamoxifen exposure, which is why every excised polyp requires pathology.
- Prognosis
Excellent for a benign polyp: hysteroscopic polypectomy is curative for the great majority of polyps, with resolution of the associated bleeding.
- Prevention
Correct chronic unopposed-estrogen exposure: manage PCOS, obesity-related anovulation, and other chronic anovulatory states with cyclic or continuous progestin to reduce focal endometrial overgrowth.
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- Evaluation of abnormal uterine bleeding
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