What is the Best Treatment for Uterine Polyps?

Best Treatments for Uterine Polyps: Treatment, Lifestyle & Prevention

Uterine polyps, or endometrial polyps, are localized overgrowths of the endometrial lining inside the uterus. Despite being usually benign, the polyps may lead to symptoms such as abnormal menstrual bleeding, spotting intermenstrual, and infertility.

Management is based on several variables, including the patient's age, reproductive intention, severity of symptoms, and risk of malignancy. Effective treatment modalities vary from conservative management to surgical resection, with hysteroscopic removal as the current gold standard.

Let’s discuss some of the most evidence-based methods of diagnosis and treatment for uterine polyps, including indications for non-surgical therapy and how health insurance can facilitate access to such care.

How Are Uterine Polyps Diagnosed Accurately?

Diagnosis of Uterine Polyps requires a combination of clinical evaluation and imaging modalities:

Transvaginal Ultrasound (TVS)

For the majority of cases, the first imaging method, TVS, can detect intrauterine lesions as isoechoic or hyperechoic masses. Color Doppler may reveal a central feeding vessel, a hallmark feature of endometrial polyps.

Saline Infusion Sonography (SIS)

This procedure enhances visualization by providing sterile saline into the uterine cavity that outlines the endometrial layers. It enhances sensitivity for the detection of small or sessile polyps, which are not visualized on routine ultrasound.

Hysteroscopy

Considered the definitive diagnostic tool, hysteroscopy allows direct inspection of the uterine cavity. It also enables immediate polyp removal during the same procedure, making it both diagnostic and therapeutic.

Endometrial Biopsy

It is helpful in determining hyperplasia or malignancy in high-risk individuals. However, due to the focal nature of polyps, biopsy may miss the lesion unless image-guided sampling is employed.

These modalities combined enable clinicians to ascertain the presence, size, vascularity, and pathologic potential of uterine polyps for appropriate planning of therapy.

Can You Remove Uterine Polyps Without Surgery?

Yes, some small uterine polyps can disappear on their own or be treated conservatively without emergency surgery, particularly if they are small, not symptomatic, and found incidentally on imaging.

Watchful Waiting

Premenopausal women with small polyps (<1.5 cm) and no troublesome symptoms can be treated with observation only. Follow-up with a transvaginal ultrasound or hysterosonography every few months ensures that the polyps are not enlarging or causing endometrial changes.

Hormonal Therapy

Short-term treatment with the following hormonal drugs occasionally controls the bleeding and decreases polyps:

• Progestins (such as norethisterone) counteract estrogen-stimulated growth.
• Combined oral contraceptives will normalize menstruation.
• GnRH agonists (such as leuprolide) inhibit the secretion of ovarian hormones, but this is not routinely employed because of side effects.

However, these are symptomatic therapies and do not remove the polyp tissue. Recurrence after cessation of the drug is common. Non-surgical interventions are therefore adjunctive or temporizing.

When is Surgical Removal Necessary?

Surgical removal of polyps in the uterus is indicated in certain clinical situations in which treatment with conservative approaches will be unsafe or ineffective. The following signs of surgery are:

• Intractable or severe AUB that cannot be controlled by medical treatment
• Polyps larger than 1.5 cm in size are not as likely to be spontaneously regressed.
• Infertility or recurrent miscarriage, where polyps can impede implantation or be a cause of disruption of embryonic growth
• The existence of any endometrial polyp in postmenopausal women is associated with an increased risk of neoplastic change.
• Suspicion of malignancy or atypia on radiologic or histologic diagnosis, requiring total removal and pathologic evaluation

These indications enable gynecologists to choose patients most likely to benefit from definitive surgical treatment, e.g., hysteroscopic polypectomy.

What Are the Alternatives to Hysteroscopy?

If hysteroscopy is unavailable or not possible, alternatives are:

Hysterectomy

Seldom indicated, hysterectomy is reserved for:

• Recurrent polyps unresponsive to conservative or hysteroscopic treatment
• Endometrial cancer or hyperplasia
• Women who are no longer worried about fertility and who have other gynecologic comorbidities (e.g., fibroids)

It is a significant surgical procedure with long-term implications and is not the first-line therapy for benign polyps.

Are Uterine Polyps Linked to Cancer?

Even though most of the uterine polyps are benign, some minority can have precancerous or malignant changes, particularly in:

• Postmenopausal women
• Polyps >1.5 cm in size
• Polyps with abnormal vascularity
• Tamoxifen-treated patients (for breast cancer)
• Obese or PCOS patients

In such high-risk cases, histopathological examination is essential after removal. EIN or endometrial adenocarcinoma can be present in <5% of cases.

Can Uterine Polyps Cause Infertility?

Yes, uterine polyps have been found to affect fertility in several ways:

• Obstruction of the uterine cavity or cervical canal, rendering it exclusive for sperm migration
• Change of endometrial receptivity, diminishing the probability of successful embryo implantation
• Local chronic inflammation, which is deleterious to the environment for embryo growth
• Endocrine disturbances, especially in the luteal phase, result in suboptimal endometrial care

Clinical experience confirms that the elimination of polyps via hysteroscopic polypectomy can significantly enhance pregnancy outcomes, particularly in patients receiving assisted reproductive therapies like intrauterine insemination (IUI) or in vitro fertilization (IVF).

Do Uterine Polyps Recur After Treatment?

Yes, uterine polyps do recur even after removal, especially in some high-risk women. Recurrence is more likely in:

• Women with continued estrogen dominance, which triggers the overgrowth of the endometrium
• The situation in which the base of the polyp (stalk) was not completely removed, resulting in the recurrence
• Patients with an underlying pathology of the endometrium, such as hyperplasia or chronic endometritis
• Other risk factors for recurrence include obesity, PCOS, and poorly controlled diabetes, all of which may provide a hormonally unbalanced environment in which recurrence is at heightened risk.

To decrease the risk of recurrence, most clinicians advocate for repeated periodic imaging, measures for control of hormones, and, for some patients, treatment with progestin following the procedure. Treatment of underlying metabolic or endocrine disease is most critical in long-term treatment and enhanced reproductive outcomes.

What Should Patients Expect During Recovery?

Most patients experience a quick and uncomplicated recovery following hysteroscopic polypectomy, as the procedure involves minimal tissue disruption. Most patients have:

• Minimum downtime, with the majority recovering between 24 and 72 hours
• Light cramping or pelvic discomfort, which can be treated with an over-the-counter painkiller
• Light vaginal spotting or discharge for 2 to 3 days following the procedure
• Normal activities resumed within 2 to 3 days, though rest is recommended for the first 24 hours.
• It is best to recommend most patients refrain from sexual intercourse, use of tampons, or vaginal douching for 1 to 2 weeks to reduce the risk of infection and heal the endometrial lining.

Follow-up is necessary and can involve:

• Discussion of histopathology findings to establish the nature of the polyp and rule out malignancy
• Institution of hormonal therapy (e.g., progestins or combined oral contraceptives) for prevention of recurrence in appropriate cases
• Repeated imaging examinations, like transvaginal ultrasound, to monitor endometrial healing and neoplasia formation

In addition, such patients with underlying disturbances of hormones can be referred to an endocrinologist to manage long-term risk factors.

Conclusion

Uterine polyps are a common gynecological condition that may lead to abnormal bleeding, infertility, and, in advanced cases, malignancy. Observation or hormonal management is adequate for some, but hysteroscopic excision is the optimal and most effective treatment.

Effective diagnosis through hysteroscopy and ultrasound with subsequent selective excision results in relief of symptoms along with restoration of reproductive function.

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