What are polyps?
Polyps are growths of mucous tissue in the uterus (this tissue is called the endometrium). They can resemble a bell clapper and they range in size from several millimeters to several centimeters.
They are often the source of bleeding in between menstrual cycles (metrorrhagia). However when they are small they may exhibit no symptoms at all.
When polyps are large, or when they are in an area of the uterus where the embryo implants itself (at the back) then they can contribute to infertility.
Except for women who are peri or post menopausal, polyps may (although it is seldom) degenerate and become cancerous. Histological analyses are performed to determine if they are cancerous or pre cancerous.
Polyps can be detected with an ultrasound scan via the vagina. However decisions about their type (benign or malignant), their position and whether or not they need to be removed are made based on the results of a scheduled hysteroscopy that allows the clinician to fully view the situation.
How are polyps removed?
In the past, polyps were removed with a curettage procedure. Nowadays, curettage is seldom used as it is carried out without a view of the area and sometimes some of the growths are not fully removed.
Surgical removal during a hysteroscopy procedure allows the clinician to look inside the uterine cavity, select and then remove the polyp(s) without touching any other part of the cavity. Thus the rest of the cavity remains intact.
Surgical resection of this type is taking over from the traditional curettage procedure which is considered nowadays to be somewhat obsolete because the clinician cannot view the area in realtime and the procedure can result in some of the growth tissue not being completely removed.
Using an endoscope with a camera attached (the more modern method) allows for a more precise procedure and avoids compromising a patient’s fertility. If the patient has numerous polyps then this methods allows for their precise individual removal. Each polyp is subsequently analysed separately.
For post-menopausal patients and those who no longer wish to fall pregnant, endometrial ablation may be combined with polyp removal. This involves removal of the endometrium (the mucous membrane which forms the lining of the uterus). This is in order to avoid the growth of additional polyps beside the area of the polyps that were removed. Endometrial ablation increases the chances of no polyp regrowth.
For those patients in their child-bearing years, diagnostic hysteroscopy procedures are performed at the doctor’s clinic to monitor progress after an operative hysteroscopy. This is usually performed one or two months after the operative hysteroscopy in order to monitor the uterine cavity and check that healing is underway.