Endometrial Polyps

Introduction

• Description: Endometrial polyps are fleshy tumors that arise as local overgrowths of the endometrial glands and stroma and project beyond the surface of the endometrium. They are most common in the fundus of the uterus but may occur anywhere in the endometrial cavity. They are generally small (a few millimeters) but may enlarge to fill the entire cavity.

• Prevalence: Up to 10% of women (from autopsy studies); 20% of uteruses removed because of cancer.

• Predominant Age: 40–50 years; infrequent after menopause.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Unknown. A role for unopposed estrogen is hypothesized.

• Risk Factors: Unopposed estrogen use, obesity, tamoxifen therapy (up to 36% of tamoxifen users), Lynch and Cowden syndromes.

Signs and Symptoms

• Asymptomatic (most).

• Abnormal bleeding (most common intermenstrual bleeding and menorrhagia, perimenopausal bleeding). One-fourth of women with abnormal bleeding patterns have an endometrial polyp.

• Polyps with long pedicles may protrude from the cervix.

  

Diagnostic Approach