Endometrial/Uterine Polyps

An endometrial or uterine polyp is an abnormal growth on the inner wall of the uterus. They either arise from the uterine wall by a stem (think of a tree) or directly, and they can be as small as a seed or fill the entire uterine cavity. They have been reported to be sensitive to the effects of estrogen (Nijkang, Anderson, Markham, & Manconi, 2019). They may be asymptomatic, but they can cause irregular bleeding (like spotting in between periods or bleeding in post-menopausal women), heavier bleeding, and/or cramp-like pain. Endometriosis patients are much more likely to have endometrial polyps (Shen et al., 2011). 

Endometriosis and endometrial/uterine polyps:

• Shen, L., Wang, Q., Huang, W., Wang, Q., Yuan, Q., Huang, Y., & Lei, H. (2011). High prevalence of endometrial polyps in endometriosis-associated infertility. Fertility and sterility, 95(8), 2722-2724. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21575952/

“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.” 

• Kim, M. R., Kim, Y. A., Jo, M. Y., Hwang, K. J., & Ryu, H. S. (2003). High frequency of endometrial polyps in endometriosis. The Journal of the American Association of Gynecologic Laparoscopists, 10(1), 46-48. Retrieved from https://www.jmig.org/article/S1074-3804(05)60233-2/abstract 

“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.” 

• Park, J. S., Lee, J. H., Kim, M., Chang, H. J., Hwang, K. J., & Chang, K. H. (2009). Endometrium from women with endometriosis shows increased proliferation activity. Fertility and sterility, 92(4), 1246-1249. Retrieved from https://www.fertstert.org/article/S0015-0282(09)00869-3/pdf 

“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.”  

• Indraccolo, U., & Barbieri, F. (2011). Relationship between adenomyosis and uterine polyps. European Journal of Obstetrics & Gynecology and Reproductive Biology, 157(2), 185-189. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21470766/

“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.” 

References

Nijkang, N. P., Anderson, L., Markham, R., & Manconi, F. (2019). Endometrial polyps: pathogenesis, sequelae and treatment. SAGE open medicine, 7, 2050312119848247. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501471/ 

Shen, L., Wang, Q., Huang, W., Wang, Q., Yuan, Q., Huang, Y., & Lei, H. (2011). High prevalence of endometrial polyps in endometriosis-associated infertility. Fertility and sterility, 95(8), 2722-2724. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21575952/