How Endometrial Polyps Can Affect Fertility

Endometrial Polyps: Causes, Symptoms, and Impact on Fertility

An endometrial polyp is an abnormal growth of tissue that develops from the inner lining of the uterus, known as the endometrium. These polyps form due to an overgrowth of endometrial cells. They are commonly seen in women of reproductive age, but can also occur in women between 35 and 40 years and after menopause.

Most endometrial polyps are benign (non-cancerous). However, in some cases, they may contain precancerous changes or rarely develop into cancer.

Endometrial polyps can vary greatly in size, ranging from a few millimetres to several centimetres. They may be as small as a sesame seed or as large as a golf ball. These growths often cause abnormal uterine bleeding and can interfere with fertility.

Causes

The exact cause of endometrial polyps is not clearly known. However, hormonal imbalance, especially increased levels of estrogen, is believed to play a key role in their development. Polyps tend to grow in response to circulating estrogen in the body.

Risk Factors

Certain factors increase the risk of developing endometrial polyps or turning them precancerous, including:

• Being in the premenopausal or postmenopausal stage
• History of high blood pressure
• Overweight or obesity
• Use of tamoxifen for breast cancer treatment

Signs and Symptoms

Women with endometrial polyps may experience:

• Irregular menstrual cycles with unpredictable timing and flow
• Spotting or bleeding between periods
• Vaginal bleeding after menopause
• Difficulty conceiving or infertility

Women experiencing any of these symptoms should consult a gynecologist promptly.

Endometrial polyps can act like a foreign body inside the uterus and interfere with embryo implantation, which may result in infertility.

Diagnosis

Endometrial polyps can be diagnosed using the following methods:

• Transvaginal Ultrasound (TVS):
• Performed in the first half of the menstrual cycle, after bleeding has completely stopped.
• Sonohysterography:
• A saline solution is introduced into the uterus through a catheter, followed by a transvaginal scan to visualize the polyp within the uterine cavity clearly.
• Hysteroscopy:
• A thin telescope is inserted through the vagina into the uterus, providing a detailed and panoramic view of the uterine cavity.

Treatment

• Asymptomatic, non-cancerous polyps may not require immediate treatment and can be monitored over time.
• Hormonal medications such as progesterone may be prescribed to help regulate hormone levels.
• Very small polyps may be managed with endometrial scratching and biopsy as an outpatient procedure.
• Premenopausal and postmenopausal women may require Dilation and Curettage (D&C), with tissue sent for histopathological examination to rule out precancerous changes.

For women facing infertility, hysteroscopic removal of the polyp is recommended. The removed tissue is examined, and endometrial scratching is often performed to promote healthy tissue regeneration and improve implantation chances.

Conclusion

Early diagnosis and appropriate treatment of endometrial polyps are crucial, especially in women experiencing infertility. Timely medical intervention can significantly improve reproductive outcomes and overall uterine health.