Endometrial polyps

Symptoms

• Spotting or bleeding between periods
• Prolonged or heavy periods
• Bleeding after the menopause
• Difficulty getting pregnant (in some patients)

Polyps often cause no symptoms and are found by chance on a routine ultrasound.

Diagnosis

Transvaginal ultrasound is the first step. Ultrasound with saline instilled into the uterus (sonohysterography) or direct hysteroscopy shows the polyp clearly.

Treatment

Polyps are removed by hysteroscopy, with no abdominal incision (hysteroscopic polypectomy). Which polyps should be removed depends on the size of the polyp, symptoms, age and pregnancy plans:

• Removal is recommended for polyps that cause bleeding, are found after the menopause, or are found in women planning a pregnancy.
• Before the menopause, small polyps that cause no symptoms can be monitored; some disappear on their own.

Hysteroscopic polypectomy

Hysteroscopic polypectomy is the removal of a polyp under direct vision using a thin camera (hysteroscope) passed through the cervix. No abdominal incision or stitches are needed.

• Preparation: the procedure is ideally planned for the first days after your period has finished, when the uterine lining is thin.
• Anaesthesia: performed under brief general anaesthesia (sedation); no pain is felt during the procedure.
• Procedure: the uterine cavity is distended with fluid, the polyp is seen on the screen and removed at its base with fine instruments passed through the hysteroscope. The rest of the uterine lining is preserved. The duration depends on the number and size of the polyps but is usually short.
• Pathology: the removed tissue is always sent for pathological examination.
• Afterwards: patients go home the same day. There may be mild cramping and spotting for a few days. Tampons, swimming and intercourse should be avoided during this time.

When can I try to get pregnant after polyp removal?

Because hysteroscopic polypectomy does not damage the uterine wall and preserves the uterine lining, a long wait before trying to conceive is usually unnecessary. Most women can start trying once the bleeding has stopped and after their first period following the procedure.

For women planning IVF or intrauterine insemination, treatment can often start in the next cycle. The waiting time may be longer if the polyp was large or multiple, or if other procedures (septum, fibroid, etc.) were performed in the same session. Your doctor will advise on the right timing after the pathology result and a follow-up examination.