II. Epidemiology
- Lifetime Prevalence: 8-35% (Incidence increases with age)
- Age of diagnosis peaks 40-49 years
III. Pathophysiology
- Localized proliferation of the endometrial glands and stroma that develops within uterine cavity
IV. Risk Factors
- Endometrial Hyperplasia (and Unopposed Estrogen)
- Tamoxifen
- Obesity
- Postmenopausal
- Hormone Replacement Therapy
- Genetic Syndromes
V. Symptoms
- Often asymptomatic
- Intermenstrual bleeding
- Other uncommon symptoms
VI. Signs
- Fleshy mass ranging in size from millimeters to centimeters
- May be single, multiple, or diffusely filling the uterine cavity
- Not typically seen on exam (unless polyps prolapse through Cervix)
VII. Differential Diagnosis
- Cervical Cancer
- Endometrial Cancer
- Prolapsing submucosal Uterine Fibroids
-
Cervical Polyps
- Cervical canal lesions that are soft, mobile and friable
- Typically visible within the cervical canal on speculum exam
- Very low malignancy risk
- Asymptomatic in most patients
- Intermenstrual or postcoital bleeding may occur
- Large lesions may rarely obstruct the endocervical canal and lead to Infertility
VIII. Imaging
-
Transvaginal Ultrasound
- Endometrial Polyps appear as hyperechoic lesions
-
Endometrial Hyperplasia may also be present (echogenic endometrial thickening)
- Endometrial Biopsy if >4 mm thickness
IX. Management
- Observation for asymptomatic low risk lesions
- Many resolve spontaneously (esp. premenopausal women)
- Periodic monitoring with Ultrasound
- Hysteroscopy with polypectomy
- Characterizes full extent of lesion and allows for excision and pathology exam
- Hysterectomy may be considered as an alternative
- Indications
- Higher risk lesions
- Symptomatic patients
- Larger polyps (>1.5 cm, less likely to spontaneously resolve)
X. Prognosis
- Endometrial Polyps are benign in 87 to 95% of cases (especially premenstrual women)
- Malignant transformation occurs in up to 13% of cases