Uterus

Endometrial Polyp

search

Endometrial Polyp

  • See Also
  1. Abnormal Uterine Bleeding
  2. Cervical Polyp
  • Epidemiology
  1. Lifetime Prevalence: 8-35% (Incidence increases with age)
  2. Age of diagnosis peaks 40-49 years
  • Pathophysiology
  1. Localized proliferation of the endometrial glands and stroma that develops within uterine cavity
  • Risk Factors
  1. Endometrial Hyperplasia (and Unopposed Estrogen)
  2. Tamoxifen
  3. Obesity
  4. Postmenopausal
  5. Hormone Replacement Therapy
  6. Genetic Syndromes
  • Symptoms
  1. Often asymptomatic
  2. Intermenstrual bleeding
  3. Other uncommon symptoms
    1. Abdominal Pain
    2. Pelvic Pain
    3. Infertility
  • Signs
  1. Fleshy mass ranging in size from millimeters to centimeters
  2. May be single, multiple, or diffusely filling the uterine cavity
  3. Not typically seen on exam (unless polyps prolapse through Cervix)
  • Differential Diagnosis
  1. Cervical Cancer
  2. Endometrial Cancer
  3. Prolapsing submucosal Uterine Fibroids
  4. Cervical Polyps
    1. Cervical canal lesions that are soft, mobile and friable
    2. Typically visible within the cervical canal on speculum exam
    3. Very low malignancy risk
    4. Asymptomatic in most patients
      1. Intermenstrual or postcoital bleeding may occur
      2. Large lesions may rarely obstruct the endocervical canal and lead to Infertility
  • Imaging
  1. Transvaginal Ultrasound
    1. Endometrial Polyps appear as hyperechoic lesions
    2. Endometrial Hyperplasia may also be present (echogenic endometrial thickening)
      1. Endometrial Biopsy if >4 mm thickness
  • Management
  1. Observation for asymptomatic low risk lesions
    1. Many resolve spontaneously (esp. premenopausal women)
    2. Periodic monitoring with Ultrasound
  2. Hysteroscopy with polypectomy
    1. Characterizes full extent of lesion and allows for excision and pathology exam
    2. Hysterectomy may be considered as an alternative
    3. Indications
      1. Higher risk lesions
      2. Symptomatic patients
      3. Larger polyps (>1.5 cm, less likely to spontaneously resolve)
  • Prognosis
  1. Endometrial Polyps are benign in 87 to 95% of cases (especially premenstrual women)
  2. Malignant transformation occurs in up to 13% of cases
  • References
  1. Baiocchi (2009) Am J Obstet Gynecol 201(5): 462 [PubMed]
  2. Lieng (2009) J Minim Invasive Gynecol 16(4):465-71 [PubMed]
  3. Luff (2026) Am Fam Physician 113(4): 393-4 [PubMed]
  4. Salim (2011) J Minim Invasive Gynecol 18(5): 569-81 [PubMed]