Menopause can be sometimes difficult and challenging. Menopause is not a disease. But, it does have some symptoms which can be both mentally and physically challenging. Menopause is defined as the complete cessation of periods for a period of at least one year. Any bleeding post-menopause is considered abnormal and needs evaluation. Most common cause of such bleeding in the perimenopausal and menopausal age group is endometrial or intra-uterine polyps. Let’s understand Uterine polyps and the way they can be dealt with.
What are Uterine polyps?
Uterine polyps are small growths that form in the inner wall of the uterus and then slowly grow to even fill the uterine cavity. It can be single or multiple. The endometrium or the inner lining of uterine cells causes this. Opposed to what you think; these polyps are not cancerous but there are chances that a few polyps could turn cancerous.
If that happens, they are called precancerous polyps. Some can be a few millimeters while some can be the size of a golf ball. You can have only one uterine polyp or many and they generally stay contained in your uterus. They are attached to the uterine wall by a very large base or sometimes a thin stalk.
Uterine polyps can sometimes can slide through the opening of the uterus into the vagina.
What are the symptoms?
- Irregular menstrual bleeding
- Frequent, unpredictable bleeds
- Heavy menstrual periods
- Vaginal bleeding even after menopause
- In younger women, sub-infertility (not always)
- Bleeding after intercourse if it’s a cervical polyp or intra-uterine polyp prolapsing into the vagina
When are you supposed to see a doctor?
When you have irregular bleeding or any bleeding post-menopause is not normal and you need to seek doctors’ advice. Any pre or post-menstrual spotting is also an indication you should visit your doctor. If there is any irregular menstrual bleeding, you need to consult the doctor.
What are the possible causes of this?
These uterine polyps are a result of the estrogen-sensitive response.
Every month, the estrogen levels rise and fall in the woman’s body and this may be related to the lining of the uterus. This estrogen can cause it to thicken and then shed the wall when the period occurs. But when there is an overgrowth of the uterine lining, then the polyp occurs.
Another cause of polyps to occur is the age factor. They are quite common when you are nearing menopause age or if you have already completed menopause. This may be again due to the various changes in hormonal levels, that the polyps develop during this phase.
Certain risk factors contribute to polyps and they are:
- If you are peri-menopausal or have reached menopause
- You have high blood pressure
- You are obese
- You are undergoing treatment of breast cancer and taking tamoxifen, which is a drug for breast cancer therapy which can cause endometrial hyperplasia
How is it diagnosed?
Transvaginal ultrasound, hysterosonography, and hysteroscopy are the three ways of diagnosing this condition.
- In Transvaginal ultrasound, a thin wand-like device is inserted in your vagina and then it emits sound waves or shows an image of the uterus including the interior part. This may identify a uterine polyp.
- There is a related procedure called hysterosonography which is also called sonohysterography. This involves having saline injected into your uterus , which broadens the uterine cavity and this will help to give the doctor a clear view of the uterus.
- In hysteroscopy, the doctors insert a thin and lighted telescope through your vagina and cervix into the uterus. The hysteroscopy allows the doctors to examine the insides of the uterus.
Treatment of Uterine Polyps
- Small polyps do not need any treatment and they can resolve on their own. Apart from this, the treatment of these small polyps is not necessary unless the doctors have detected a possible threat of uterine cancer.
- You may be prescribed progesterone based medications to reduce symtpoms but it does not remove the polyp.
- Definitive treatment is to remove the polyp and ideal way of doing it is “see and treat” by hysteroscopy. Hysteroscopic guided polyp removal is the best way of dealing with it as it assures the complete polyp is removed and you don’t need multiple procedures.
During the microscopic examination, if they find any cancerous cells, they will talk to you about the next possible steps you need to take. Once removed, polyps usually do not need any further treatment but if they recur, they need to be treated again.
Prevention of Uterine Polyps
You cannot prevent uterine polyps. However, you can have regular gynecological checks to identify this condition. Make sure you are not having any risk factors that increase the chance of developing polyps.
Nobody actually knows the exact cause of the uterine or endometrial polyps as it has also been found in those women who haven’t had any symptoms. It is best to get regular screening and take advice from your Gynecologist on the best course of action if you have polyps in the uterus.