My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
Lying there during what was supposed to be only a uterine biopsy, I hear the doctor say, “Wow, yeah ok I can see what has been causing some of your pain. You have a polyp right at the base of your uterus.”
My doctor is a bit of a nerd (his own description). I imagine that is a good thing for a doctor to be, and he was, very excitedly, “nerding out” about my particular polyp. He kept telling the nurse that he had never seen such a perfect specimen, and he wished he would have taken a picture for his students.
After he moved on to what this polyp meant to me, he explained how uterine polyps can affect a person. As he began to describe the symptoms one could face, tears streamed down my cheeks.
Slowly, I began to realize just how much I needed to hear that what I had been experiencing had a name and a treatment plan. After 15 years of “I’m sorry, we don’t know why you are experiencing this pain”, it was such a relief to have some validation and hope.
In this article I will discuss what uterine polyps are, the symptoms they can cause, and the treatment options available. Along the way I will share my own experience with symptoms, as well as what scientific research teaches us.
When the cells in the uterine lining become overgrown they can form uterine polyps. Sometimes they are also called endometrial polyps. This is because the lining of the uterus is also known as the endometrium.
The polyps are attached to the uterus lining with a stalk, and they can grow in size rapidly. Some women may not even ever know they had a polyp as they may have passed uterine polyps during menstruation. However, if the polyps cause problems, a doctor may remove them.
Though anyone with a uterus can get polyps, they are most common in those who are going through, or have gone through, menopause. Uterus owners under 20 years of age rarely experience them, but women of all ages who have irregular periods due to a condition such as PCOS are at higher risk.
There are no absolute known uterine polyps causes. However, the growth may be affected by hormones, specifically estrogen circulating through the blood, or due to an irregular menstrual cycle which means the uterus lining is not being properly shed.
Polyps can grow in many areas throughout the body. Most often they are benign, but they can cause other problems, such as cancer. Polyps can grow throughout the female reproductive system in areas such as:
Endometrial polyp symptoms that can be experienced include:
For me, the pain I experienced presented during heavy periods with contraction-like spasms. Though pain is uncommon, the length and severity of the pain people experience will vary greatly from person to person. Pain tolerance is relative.
There are several ways to diagnose polyps. Let’s find out about them now.
Some polyps are discovered in the uterus while a uterine biopsy is being performed. A small amount of tissue is collected to be tested for cancer cells. Uterine biopsy is often used before a planned surgery, such as hysterectomy.
A D&C is a procedure that takes place when the cervix is dilated so that a spoon-like instrument called a curettage can be inserted and used to scrape out the lining of the uterus. This procedure can reveal polyps, and it can also be used to remove them.
A hysteroscopy is a procedure where a camera is guided into the uterus. During a hysteroscopy, uterine polyps can be seen and diagnosed.
Uterine polyp ultrasound is not the go-to for diagnosis, but polyps can be seen during ultrasound. Uterine and cervical polyps during pregnancy are often found and monitored through ultrasound.
Cancerous uterine polyps do exist. Some polyps can be precancerous on their own as well. There are some factors that play into this as well.
Having a hyperplastic endometrial, or lining of the uterus, means an abnormal thickening. This is said to increase the chances of cancer.
Endometrial polyps that are precancerous or cancerous often have the same symptoms and lack of symptoms as the benign ones do. If the polyp is large, and is causing the symptoms mentioned above, your doctor may want to remove it. After removal it will be sent to the lab to make sure there is no cancer.
Let’s look at a study called, Clinical Factors and Malignancy in Endometrial Polyps. Analysis of 1027 cases found that, of the polyps observed during the study: “Benign polyps accounted for 95.8% of the total, premalignant for 2.67%, malignant for 1.54%.”
Their data also showed that post-menopausal and older women (>60y) with endometrial polyps have a higher risk of developing a related endometrial cancer.
The study concluded that: “Special attention should be drawn to symptomatic postmenopausal patients that appear to be at higher risk of malignancy. Symptomatic pre-menopausal women and asymptomatic post-menopausal women with polyps may be a group with intermediate-risk. These patients should undergo an individualized management plan, balancing both risks and benefits of surgical intervention after discussion with the patient.”
Although the cancer risk appears to be low, it is best to never ignore a uterine polyp. Female Health & Fertility magazine’s own Editor-in-Chief was in the 1.54% at just 34 years old and required a hysterectomy.
There are a variety of options for uterine polyps treatment. The available options will depend on symptoms, situation, and other conditions (such as the aforementioned cancer) that may also be present.
You do not have to suffer unnecessarily. Some treatments include:
Having uterine polyp removal surgery is effective. It is important to note though that polyps can grow back. It is important to discuss your risk factors with your doctor.
In a study called, Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy, we learn that around 43% of women experience recurrence of endometrial polyps after removal. The study concluded: “A higher number of endometrial polyps and longer follow-up duration are associated with a greater potential of polyp recurrence after hysteroscopic polypectomy.”
Two weeks after my initial diagnosis, during my follow-up appointment. My doctor and I discussed my options.
“Basically you have three choices, Mrs Andersen. Based on your age, history, and current level of symptoms, you can either do nothing, have it removed here in the office, or have a hysterectomy.
“The hysterectomy will eliminate the fibroids, polyp, uterus, cervix, and tubes. I will keep your ovaries if at all possible. It is up to you.”
Since I had unexplained pain, heavy periods, fibroids, had my tubes tied 17 years before, and was at the age of 41, I chose hysterectomy. In June I had my surgery. Three months later and completely healed, I was living my best, pain free, and active life.
The risks of refusing endometrial polyp treatment are:
Not being treated, but being monitored by your doctor, greatly reduces the risks.
What are the best treatments for uterine polyps?
The best treatments are the ones that work for you with your doctor’s advice. Some choose to have them removed in the office, others, like me, choose hysterectomy. Each person is different, and will have different goals and needs.
One thing I learned through this process was that there can be more in your uterus than meets the eye. During my hysterectomy, they found more fibroids than they had originally thought, more polyps, and a whole host of other problems that they were able to take care of through the surgery.
The bottom line is: everyone is different. Polyps in the uterus are common, but those that end up with cancer are rare.
Treatment options can greatly reduce symptoms. It is always good to keep up with regular checkups and make the best possible decisions for your health with your medical team.
If you are dealing with polyps, please know you are not alone, and you are not crazy. The options can improve your quality of life and, if you are anything like me, the diagnosis alone may improve your mental health.
Ricciardi, E., Vecchione, A., Marci, R., Schimberni, M., Frega, A., Maniglio, P., Caserta, D., & Moscarini, M. (2014). Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases. European journal of obstetrics, gynecology, and reproductive biology, 183, 121–124. doi.org/10.1016/j.ejogrb.2014.10.021
Yang, J. H., Chen, C. D., Chen, S. U., Yang, Y. S., & Chen, M. J. (2015). Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy. PloS one, 10(12), e0144857. doi.org/10.1371/journal.pone.0144857
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