Effects of Endometrial polyps on fertility

July 22, 2021
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Endometrial polyp is a tissue growth arising from the inner wall of the uterus called the endometrium. Overgrowth of cells in the lining of the endometrium leads to the formation of endometrial polyps. Endometrial polyps are common in women of childbearing age but can also occur in women undergoing menopause as well as 35 to 40 years. These are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer which is known as precancerous polyps.

Uterine polyp size range in size from a few millimetres to several centimetres. It can be the size of a sesame seed or as big as a golf ball.

Endometrial polyp causes abnormal uterine bleeding and can lead to infertility.

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Cause

The exact cause for an endometrial polyp is unknown. Hormonal changes may play an important role. Endometrial polyp is said to grow in response to circulating estrogen hormones in women.

Risk factors

Certain risk factors may lead to the development of an endometrial polyp into a precancerous lesion that includes the following.

  • Women in their premenopausal or postmenopausal
  • Women with a high blood pressure history.
  • Being overweight
  • Women under medication for breast cancer (taking tamoxifen).

Signs and Symptoms

Woman with endometrial polyp notice the following signs and symptoms-

  • Irregular menstrual bleeding, women might have frequent, unpredictable menses of variable length and heaviness
  • Bleeding in between menstrual periods may be seen (spotting from the vagina)
  • Vaginal bleeding may be observed after menopause
  • Women with endometrial polyp might have difficulty in conceiving.

Women who notice any of the above symptoms should consult a gynecologist without delay.

The polyp can act as a foreign body and can affect implantation(that is sticking of the embryo to the uterus) thus causing infertility.

Diagnosis

TVS: Polyps are diagnosed by transvaginal ultrasound done in the first half of the menstrual cycle when the bleeding is completely over.

Sonohysterography: Where is saline is inserted into the uterine cavity through a catheter and transvaginal scan is done to see the polyp dangling in the fluid inside the cavity.

Hysteroscopy: It is the insertion of the telescope into the uterus through the vagina and has a panoramic view of the uterus.

Treatment: The noncancerous polyp that shows no symptom requires no treatment. You need to wait and see if it goes away on its own.  The doctor may advise certain medications such as progesterones which will help control hormone levels.

If very small polyp can do endometrial scratching using a pipelle as an OPD procedure and take an endometrial biopsy. But premenopausal women and postmenopausal women should undergo D and C and the tissue sent for histopathology to rule out any precancerous changes.

Women with endometrial polyp are unable to conceive and may undergo removal of the polyp for treating infertility. Hysteroscopic polyp removal is advised and the tissue is sent for histopathological examination. At the same time, endometrial scratching is done which will help new healthy tissue to grow.

So the diagnosis of endometrial polyps and treatment is very essential in infertility treatment.