When should endometrial polyps be removed

Endometrial polyps (internal nodules of the uterus) form from an excessive thickening of the innermost layer of the uterus, called the endometrium. Although some may go unnoticed and do not cause any discomfort, it is common to find many patients with irregular menstruation or bleeding and even heavy periods. In most cases they are only detected when patients attend gynecological check-ups and a transvaginal ultrasound is performed.

What symptoms can endometrial polyps produce?

They can frequently produce symptoms such as postmenopausal bleeding, heavy or irregular menstruation, and even difficulties in becoming pregnant. For any of these symptoms it is best to see a specialist in Gynecology and Obstetrics to perform an examination and perform the most appropriate diagnostic tests.

If the specialist suspects the presence of a polyp, a transvaginal ultrasound and/or hysteroscopy will be performed, which are painless and quick tests that can confirm or rule out the presence of polyps. In such a case, it is also important to identify the size, how many there are and exactly where they are located.

When is it recommended to remove an endometrial polyp?

When a polyp is diagnosed, the specialist will take into account the following aspects to decide whether it is recommended to remove it or not: whether the patient has symptoms or not, the size of the polyp/s, the patient’s age, whether she has one polyp or several, and whether she wants to become pregnant.

Based on the above, the following protocol is usually followed:

  • If the patient has not reached menopause, the size of the polyp is small and does not cause symptoms, it can be limited to a follow-up to monitor its evolution. However, nowadays we have hysteroscopy, which is an outpatient surgical procedure, safe and very effective in removing these polyps, so the alternative of removing the polyps is the best choice.
  • If the patient has not reached menopause and has no symptoms but has several polyps, or the polyp grows, it is recommended to remove it and not take risks.
  • If the patient has reached menopause, we will consider removing the polyp, even if it does not cause symptoms and is small, to avoid the risk of malignancy.
  • If the patient wants to get pregnant and does not succeed, it is recommended to remove the polyp.
  • If there are symptoms, it is advisable to remove the polyp, regardless of the patient’s age.
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What is a hysteroscopy to remove an endometrial polyp like?

Normally polyps are removed by hysteroscopy which, as mentioned above, is a quick, minimally invasive surgical procedure performed vaginally. It is an operation that can be performed on an outpatient basis, without an operating room or hospital admission. Very briefly, it consists of the following: hysteroscopy is a type of endoscopy that is performed inside the uterus, introducing a camera the thickness of a pencil (millimeter) and, next to it, an instrument that allows the endometrial polyp to be removed under direct vision. It is really a minor surgery, but it is necessary to be trained and qualified to perform it, that is why there are centers specialized in this type of minimally invasive interventions.