Uterine Polyps: Diagnosis and Treatment

Uterine polyps are growths that develop in the lining of the uterus. Most uterine polyps are benign, which means that they're not cancer. However, some precancerous changes of the uterus, called endometrial hyperplasia, or uterine cancers appear as uterine polyps. A tissue sample of the removed polyp is analyzed for signs of cancer to ensure a proper diagnosis.

Diagnosis

The following tests might be used to diagnose uterine polyps:

• Transvaginal ultrasound. A slender, wandlike device placed in the vagina emits sound waves and creates an image of the uterus, including its insides. During this procedure, you lie on an exam table while a health care provider or a medical technician puts a wandlike device, known as a transducer, into the vagina. Sound waves from the transducer create images of the uterus, ovaries and fallopian tubes. A polyp might be clearly present or there might be an area of thickened endometrial tissue.
• Hysterosonography. A related procedure, known as hysterosonography (his-tur-o-suh-NOG-ruh-fee) — also called sonohysterography (son-oh-his-tur-OG-ruh-fee) — involves having salt water (saline) injected into the uterus through a small tube placed through the vagina and cervix. The saline expands the uterus, which gives a clearer view of the inside of the uterus during the ultrasound. An ultrasound probe gets images of the inside of the uterus to check for anything unusual.
• Hysteroscopy. This involves inserting a thin, flexible, lighted telescope (hysteroscope) through the vagina and cervix into the uterus. Hysteroscopy allows for viewing the inside of the uterus. During hysteroscopy, a thin, lighted instrument (hysteroscope) provides a view of the inside of the uterus.
• Endometrial biopsy. A suction catheter inside the uterus collects a specimen for lab testing. Uterine polyps might be confirmed by an endometrial biopsy, but the biopsy could also miss the polyp.

Treatment Options

Treatment for uterine polyps might involve several approaches based on the patient's condition:

• Watchful waiting. Small polyps without symptoms might resolve on their own. Treatment of small polyps is unnecessary for those who aren't at risk of uterine cancer.
• Medication. Certain hormonal medications, including progestins and gonadotropin-releasing hormone agonists, may lessen symptoms of the polyp. But taking such medications is usually a short-term solution at best — symptoms typically recur once the medicine is stopped.
• Surgical removal. During hysteroscopy, instruments inserted through the device used to see inside the uterus (hysteroscope) make it possible to remove polyps. The removed polyp will likely be sent to a lab for examination.

If a uterine polyp contains cancer cells, your provider will talk with you about the next steps in evaluation and treatment. Rarely, uterine polyps can recur; if they do, they need more treatment.

Preparing for Your Appointment

Your first appointment will likely be with your primary care provider or a gynecologist. Have a family member or friend go with you, if possible, to help you remember the information you receive.

What you can do

Make a list of the following to prepare for your visit:

• Your symptoms, even those you don't think are related, and when they began.
• All medications, vitamins and supplements you take, including doses.
• Questions to ask your provider.

Basic questions to ask your provider

• What could be causing my symptoms?
• What tests might I need?
• Are medications available to treat my condition?
• Under what circumstances do you recommend surgery?
• Could uterine polyps affect my ability to become pregnant?
• Will treatment of uterine polyps improve my fertility?
• Can uterine polyps be cancerous?

What to expect from your doctor

Some questions your provider might ask include:

• How often do you have symptoms?
• How severe are your symptoms?
• Does anything seem to improve or worsen your symptoms?
• Have you been treated for uterine polyps or cervical polyps before?
• Have you had fertility problems? Do you want to become pregnant?
• Does your family have a history of breast, colon or endometrial cancer?