Wednesday, April 2, 2014

Endometrial/Uterine Polyps

A endometrial or uterine polyp is an abnormal growth on the inner wall of the uterus. It's actually an overgrowth of the cells that line the uterus. They either attach by a stem (think of a tree) or directly. They can be small as a seed or fill the entire uterine cavity. They have been reported to be sensitive to the effects of estrogen. They may be asymptomatic. But they can cause irregular bleeding (like spotting in between periods or bleeding in post menopausal women), heavier bleeding. and in my case they seem to cause a lot of clots with periods and more uterine cramping (like my uterus is trying to give birth to itself- I wish it would! Bye bye uterus!). 

Here's what others have said: "The definitive cause of uterine polyp is not known. However, they seem to be caused by hormonal levels and usually respond to estrogen circulation by growing. Endometrial polyp often cause no symptoms. In the event that they occur, symptoms will include bleeding between menstrual periods,irregular menstrual bleeding,vaginal bleeding soon after menopause and menorrhagia; a condition characterized by excessive menstrual bleeding. When polyp blood vessels bleed, there is an increase in blood loss during and in between menstrual periods. In the event that polyp protrudes into vagina, pain would result."

The bigger question: "How do they relate to endometriosis?"

Interestingly, endometriosis patients are much more likely to have them. "In a retrospective study, examination of 431 infertile women (158 cases with endometriosis and 273 without endometriosis) showed a significantly increased frequency of endometrial polyps in patients with endometriotic infertility and no significant differences among different stages and locations of endometriosis."

Enough so that they:

"We strongly recommend hysteroscopy if endometriosis is detected in a woman undergoing evaluation for infertility, even if hysterosalpingography and transvaginal ultrasonography do not suggest endometrial polyps."   
 Even more interesting is that they have seen an increase in proliferation (aka growth):
"Examination of 631 infertile women, including 434 women with endometriosis and 197 without endometriosis, revealed an increasing incidence of endometrial polyps, especially in the test subjects with endometriosis, and advanced stages of endometriosis. Expression of Ki-67 and Bcl-2 proteins and MTT assay results were significantly higher in endometrium of patients with endometriosis than in patients without endometriosis. These showed increased proliferation activity and cell proliferation markers not only clinically but also pathologically."
They are also associated with adenomyosis:

"The presence of multiple endometrial polyps seemed to be associated with the presence of adenomyosis (p=0.016). The presence of cervical polyps was significantly associated only with presence of adenomyosis (p=0.002). The results clearly demonstrate an association between adenomyosis and uterine polyps. The pathogenetic role of adenomyosis in the development of polyps should therefore be investigated further."