Endometrial polyp

Disease Description (Causes and Symptoms)

• Definition: A lesion in which a localized part of the endometrium proliferates excessively and protrudes into the uterine cavity (endometrial polyp). Most are solitary, while approximately 20% are found to be multiple. They mainly occur in the uterine fundus (base, fundus).
• Pathophysiology: Formed by excessive proliferation of localized endometrial glands and stroma, and composed of vascular-rich connective tissue. It is associated with estrogen stimulation, and age (around menopause), hormonal effects, and tamoxifen use are known risk factors.
• Causes (summary): No clear single cause is known. Associations have been reported with increasing age, hormonal (estrogen) effects, coexisting uterine fibroids, and the use of medications such as tamoxifen.
• Main symptoms:
  • Often asymptomatic
  • Abnormal vaginal bleeding (heavy menstrual bleeding, bleeding between periods)
  • Irregular menstruation, menstrual pain, increased vaginal discharge
  • Rarely, infertility (particularly when the polyp involves the uterine cavity)
• Risk of malignancy: Rare overall (approximately 5% or less), but the proportion of malignant or dysplastic findings is relatively higher in postmenopausal women — pathological examination after removal may be recommended.

Treatment Methods

• Observation (follow-up)
  • Small polyps without symptoms may be followed while monitoring changes in symptoms or size. However, pathological examination is recommended if there is postmenopausal bleeding or findings suspicious for malignancy.
• Surgical removal (standard)
  • Hysteroscopic polyp removal (hysteroscopic polypectomy): The polyp is removed under direct visualization during the procedure and a pathological examination is performed — diagnosis and treatment are carried out simultaneously.
  • Endometrial curettage (D&C): Although widely used in the past, it may provide less complete tissue acquisition and removal than hysteroscopy. It may be performed as an adjunctive procedure.
  • Hysterectomy (removal of the uterus): Considered in cases of multiple polyps, repeated recurrence, severe heavy menstrual bleeding, or accompanying other lesions (severe uterine lesions).
• Medication treatment
  • Hormonal medications (such as progestins) or a hormonal IUD (levonorgestrel IUS) may help relieve symptoms (reduce bleeding), but they cannot reliably remove the polyp itself.
  • GnRH agonists and similar medications may be used short-term to control bleeding before surgery or improve the surgical conditions (depending on the situation).
• Precautions and complications after the procedure
  • Bleeding, infection, and uterine perforation (during hysteroscopic procedures) are possible. Additional treatment may be needed depending on the pathological examination results after removal (if dysplastic or malignant findings are present).
  • Polyps may recur, so repeat examination is needed if symptoms change.
• Prognosis
  • The prognosis is generally favorable. Malignant transformation is rare. Relief of symptoms and the recurrence rate vary depending on the removal method and patient factors.

Checklist Before an Outpatient Visit (Including Example Questions)

Items and information to prepare in advance:

• List of currently used medications (especially tamoxifen, hormonal medications, anticoagulants, etc.)
• Medical history: uterine surgery (hysteroscopy, hysterectomy, etc.), uterine fibroids, and history of breast cancer and chemotherapy or hormonal treatment
• Detailed menstrual history: start and end dates of bleeding, amount of bleeding (e.g., frequency of pad changes), and whether there is intermenstrual bleeding
• When symptoms began and how they have changed (e.g., recently increased bleeding, pain, discharge)
• Previous test results: pelvic ultrasound images, hysteroscopy/pathology results, cervical cytology (Pap test), etc. — if possible, bring imaging and test records
• Possibility of pregnancy (if a pregnancy test is needed)

Items to tell the doctor in advance at the outpatient visit (organized as example questions):

• Recent weight changes and whether hormonal treatment was started or stopped
• Symptoms of anemia caused by bleeding (dizziness, fatigue, etc.)

Examples of General Questions to Ask the Doctor

• "Do I need to have my polyp removed, or can I have it monitored? What are the criteria?"
• "What are the risks of the procedure (hysteroscopic surgery), and how long is the recovery period?"
• "How likely is my polyp to progress to cancer?"
• "How likely is recurrence after surgery, and are there ways to reduce the risk of recurrence?"

Examples of Condition-Specific Questions

• "I have bleeding after menopause. How likely is it to be an endometrial polyp, and is a pathological examination (removal) necessary?"
• "Could an endometrial polyp be a cause of infertility? How should it be managed until I become pregnant?"

(Note: The recommendations above are general medical information. Individual diagnosis and treatment should be determined based on evaluation by the attending physician and test results.)