What is worse fibroids or polyps?
Uterine Fibroids, Polyps & Abnormalities
The uterus (womb) is the area of a woman’s body where an embryo embeds and then develops into a fetus. Physical issues with the uterus such as growths or any irregularities to its structure can contribute to female infertility, recurrent miscarriage, or complications during delivery.
Uterine-related problems that can affect fertility include uterine fibroids, polyps, and abnormalities in the structure of the uterus.
Uterine fibroids, polyps & abnormalities at a glance
- Among the most common uterine issues affecting a woman’s fertility are growths, such as uterine fibroids (noncancerous muscle growths) or endometrial polyps (growths attached to the inner wall of the uterus), or abnormalities in the shape of the uterus.
- Uterine-related issues have few symptoms and are typically diagnosed using imaging tests or during a pelvic exam.
- Treatment, if needed, usually involves surgery to correct a structural abnormality or to remove the uterine fibroids and/or polyps.
What are uterine fibroids, polyps, and other abnormalities that affect fertility?
Also known as myomas or leiomyomas, uterine fibroids are noncancerous growths on the uterus’ muscular wall. Uterine fibroids often produce no symptoms, so many women do not even know they have them. If they become large enough, fibroids can obstruct the embryo from implanting on the uterine lining and prevent the mother from carrying the pregnancy to term.
According to the American Society for Reproductive Medicine, 5-10 percent of infertile women have fibroids. But some studies have shown that most women have fibroids, although most of these are asymptomatic. The exact cause of uterine fibroid growth is unknown, although research suggests genetics and female hormones (estrogen and progesterone) may play a part.
There are three main types of uterine fibroids: Subserosal, intramural and submucosal.
- Subserosal fibroids grow mostly outside of the uterus and into the abdominal cavity. Many times they do not cause symptoms.
- Intramural fibroids originate and grow within the wall of the uterus, and may negatively impact fertility and increase the risk of pregnancy loss.
- Submucosal fibroids grow and develop on the inside of the uterus and may also cause infertility and miscarriage.
- Subserosal and submucosal types may also be pedunculated, meaning they have a stalk of tissue.
Uterine polyps are bulb-shaped and caused by the overgrowth of the glandular tissue lining (called the endometrium) of the uterus.
Polyps can interfere with fertility by preventing a fertilized egg (embryo) from implanting in the uterine wall correctly.
Uterine abnormalities, congenital and acquired
Uterine anomalies are anatomical problems with the uterus that women are either born with (congenital) or that develop over time (acquired). Congenital abnormalities occur when a woman’s uterus does not develop normally. These malformations are usually present in a woman without symptoms.
Congenital abnormalities include:
- Septate uterus is when the uterus cavity is divided, or partitioned, by the septum (wall). This is the most common congenital abnormality and can be surgically corrected using hysteroscopy.
- Bicornuate is a division of the uterus cavity into two (rather than one) spaces, giving this abnormality its second name, the heart-shaped uterus. Surgery is usually not needed.
- Unicornuate is when only half the uterus forms during development. A woman with this condition will likely have two ovaries but only one will be connected to her uterus.
- Didelphys, also called the double uterus, is when a woman develops two separate uterine cavities, each with its own cervix.
Acquired uterine abnormalities, such as scarring of the uterus or the development of scar tissue, occurs when an infection or surgery alters the uterine lining. These scars can damage the lining of the uterus, making it more difficult to conceive or carry a pregnancy to term.
Symptoms and diagnosis of uterine infertility factors
Uterine fibroids may be asymptomatic but, depending on size and location, can cause heavy menstrual cycles, pain, and pressure symptoms. Polyps are very common and may be asymptomatic but occasionally cause irregular bleeding.
Many, and possibly most, uterine anomalies don’t cause symptoms, and many women may not discover issues until they have a pelvic exam or an ultrasound. When symptoms do occur, women may experience:
- Never having had a period. If the abnormality is obstructive, meaning that menstrual blood cannot flow out of the body, then the patient will have a build-up of blood behind the obstruction and the patient may have severe pain.
- Spotty or irregular bleeding during periods
- Recurrent miscarriages
- Preterm labor or abnormal positioning of the baby during pregnancy or labor
- Pain when inserting a tampon or during sex
A physician can typically diagnose issues with the uterus during a pelvic exam or using imaging tests such as ultrasound or MRI. In some cases, a physician may also recommend a hysteroscopy.
During this procedure, a doctor inserts a thin, lighted tube (hysteroscope) through the vagina and cervix into the uterus. This tube allows the physician to examine the inside of the uterus, allowing him or her to remove any growths if needed or to remove a congenital defect such as a septum.
If a uterine issue is present, it may not require treatment or impact fertility. The physician will determine if treatment is needed, depending upon the size of the growth or abnormality and whether it is affecting a woman’s health or fertility.
Treatment for uterine fibroids, polyps or other abnormalities
Not all women with uterine fibroids require treatment, and many cases only require medication. In cases where fertility is affected, surgery to remove fibroids (called a myomectomy) is usually recommended. This may be through the abdomen using a large incision, laparoscopy, or robotic surgery. If the fibroid is entirely or mostly in the uterine cavity, it may be removed using hysteroscopy, which is entirely a vaginal approach.
In rare cases, a patient with severe discomfort or bleeding due to uterine fibroids may undergo a hysterectomy, which removes the entire uterus. This eliminates the possibility of future pregnancies.
These are easily removed with a hysteroscopy, a minimally invasive procedure to view and remove abnormalities.
As with other uterine issues, treatment for uterine abnormalities depends upon the nature of the anomaly, its size, and whether or not it is affecting fertility or a woman’s health. Surgery is the usual treatment if needed.
Uterine polyps are growths that occur in the inner lining (endometrium) of your uterus. They’re attached to the endometrium by a thin stalk or a broad base and extend inward into your uterus. Uterine polyps are usually noncancerous, but they may cause problems with periods (menstruation) or fertility if they’re left untreated.
What are uterine polyps?
Uterine polyps are growths in the inner lining of your uterus (endometrium). They’re sometimes called endometrial polyps.
Uterine polyps form when there’s an overgrowth of endometrial tissue. The polyp attaches to the endometrium by a thin stalk or a broad base and extends into your uterus. Polyps may be round or oval and range in size from a few millimeters (the size of a sesame seed) to a few centimeters (the size of a golf ball) or larger. You may have one or several polyps present.
Uterine polyps are usually benign (noncancerous), but they may cause problems with periods (menstruation) or your ability to have children (fertility).
Uterine polyps can attach to the endometrium via a thin stalk.
Uterine polyps can grow as large as a golf ball.
Who is affected by uterine polyps?
Age is a major predictor of polyps. You’re most likely to develop uterine polyps in your 40s and 50s, around the time when you’re approaching menopause (perimenopause). Uterine polyps can occur after menopause (postmenopause), but they rarely affect people under 20 years old.
Your chance of developing uterine polyps also increases if you:
- Have overweight (BMI 25 < 30) or obese (BMI >30).
- Have high blood pressure (hypertension).
- Take tamoxifen, a drug that’s used to treat breast cancer.
- Receive hormone replacement therapy that involves a high dosage of estrogen.
You’re at greater risk of getting uterine polyps if you have Lynch syndrome or Cowden syndrome.
Are uterine polyps common?
It’s difficult to tell. Uterine polyps are sometimes asymptomatic, meaning they don’t cause symptoms. For this reason, many people with uterine polyps may never receive a diagnosis. Research does suggest that polyps are more common in certain populations. For instance, they’re more common in people who’ve gone through menopause than those who haven’t.
Symptoms and Causes
What are the symptoms of uterine polyps?
The most common symptom of uterine polyps is abnormal bleeding. Abnormal bleeding includes vaginal bleeding after menopause and irregular menstrual periods. Most periods last four to seven days. Normal menstrual cycles usually occur every 28 days but can range from 21 days to 35 days. Many people with uterine polyps have irregular periods.
The symptoms of uterine polyps include:
- Irregular menstrual periods (unpredictable timing and flow).
- Unusually heavy flow during menstrual periods (heavy menstrual bleeding).
- Bleeding or spotting between periods (intermenstrual bleeding).
- Infertility (being unable to become pregnant or carry a pregnancy to term).
- Vaginal spotting or bleeding after menopause (red, pink or brown blood).
- Bleeding after intercourse.
Your healthcare provider may discover asymptomatic polyps during a procedure to diagnose a separate issue. Polyps can sometimes prolapse, or slip, through your cervix. The cervix is the opening between your vagina and your uterus. In these instances, your provider may be able to see the polyp during a physical exam.
Are uterine polyps painful?
Large polyps can sometimes cause dull aching in your abdomen or lower back, similar to menstrual cramps. Pain isn’t a common symptom of uterine polyps, though.
What causes uterine polyps?
Researchers don’t know why polyps form, but hormone levels may be a factor. Estrogen plays a role in causing the endometrium to thicken each month during your menstrual cycle. This thickening likely contributes to uterine polyp growth. Many risk factors for uterine polyps involve your body being exposed to high amounts of estrogen.
Diagnosis and Tests
How are uterine polyps diagnosed?
Your healthcare provider will review your medical history and ask questions about your symptoms. If you’re postmenopausal, your provider may ask if you’ve noticed any bleeding or spotting. They’ll likely ask what medicines you’re taking. If you still get your periods, they may ask about the specifics of your menstrual cycle, including how long your periods last and how often you have them. Your provider may ask if you’ve had difficulty getting pregnant.
Your provider will also perform a gynecological exam, including a pelvic exam and a Pap smear. They may order additional tests or procedures to confirm that the growths are polyps.
These tests may include:
- Transvaginal ultrasound: Your provider inserts a slim handheld device called an ultrasound transducer into your vagina. The device emits sound waves that provide an image of the inside of your uterus, including any irregularities that may be present.
- Sonohysterography: After your initial transvaginal ultrasound, your provider may send a sterile fluid into your uterus through a thin tube called a catheter. The fluid causes your uterus to expand, providing a clearer image of any growths within your uterine cavity during the ultrasound procedure.
- Hysteroscopy: Your provider inserts a long, thin tube with a lighted telescope (hysteroscope) through your vagina and cervix into your uterus. The hysteroscope allows your provider to examine the inside of your uterus. Hysteroscopy is sometimes used in combination with surgery to remove uterine polyps.
Management and Treatment
How are uterine polyps treated?
Treatment will depend on your symptoms and other factors that increase your risk of uterine cancer. If you’re still in your reproductive years and the polyp isn’t causing symptoms, your provider may monitor it instead of treating it. The polyp may go away on its own. If you’ve gone through menopause and/or if polyps are causing symptoms, you may need treatment.
Methods of treatment include:
- Medications: Drugs that keep your hormones balanced, like progestins or gonadotropin-releasing hormone agonists, may be used to relieve symptoms. The symptoms usually return after you stop taking the medication.
- Uterine polypectomy: Your provider will likely be able to remove your polyp during hysteroscopy. A hysteroscope allows your provider to insert tools that can be used to excise (cut) and remove polyps. The advantage of hysteroscopy is that it’s precise. Your provider can visualize your polyp and remove it at the same time. They can then send the tissue to a lab for testing to check for signs of cancer.
You may need additional surgery if a polyp is cancerous. A hysterectomy, a surgery that involves removing your uterus, may be necessary in cases where the polyps contain cancer cells.
Do uterine polyps need to be removed?
It depends. If you’re pre-menopausal and not experiencing symptoms, the polyp is considered to be low risk. It may not need to be removed. If you’re postmenopausal or experiencing symptoms like abnormal bleeding, your provider may recommend removal. Your provider may also remove polyps if they could cause problems during pregnancy or negatively impact your fertility.
Is uterine polyp removal painful?
Your provider will give you medications beforehand to prevent you from feeling pain during surgery. You still may feel slight pulling or pressure.
Uterine polyps: A common reason for irregular bleeding around menopause
If you’re approaching menopause and experience vaginal bleeding outside of your normal pattern, it could be due to a condition called uterine polyps. The good news is if your polyps become problematic, they are treatable. Here’s what you need to know.
Top things to know:
- Uterine polyps are abnormal growths on the inside lining the uterus
- They occur most commonly leading up to and after menopause
- Symptoms include irregular bleeding between periods and periods that vary in length and heaviness
Smaller polyps are often not noticeable, or can go away on their own, but problematic polyps can be treated with medications, non-invasive surgery, and/or lifestyle changes.
What are uterine polyps?
Uterine polyps are abnormal growths on the inside lining of the uterus (the endometrium). They are sometimes called endometrial polyps and can cause symptoms such as irregular vaginal bleeding (1, 2).
Uterine polyps are very common. Up to 3 in 10 people may have them at some point in their lives (3, 4), but fewer than 1 in 100 people develop polyps before age 30 (3, 5). They occur most commonly leading up to and after menopause (6). Small polyps may cause no symptoms at all and can go away on their own (2, 7). In other cases, untreated polyps may cause symptoms that affect quality of life and can carry a small chance of becoming cancerous (3, 8). They may also affect fertility, but research on this topic is still lacking (9, 10).
Nearly all symptoms of uterine polyps are easy to track. Tracking your bleeding patterns, pain, and other symptoms with Clue can provide your healthcare provider with information that may help with diagnosis and in forming a treatment plan. Early treatment can reduce the risk of complications.
What you might notice
Signs and symptoms of uterine polyps include:
- Irregular bleeding between periods or after menopause
- Periods that vary in length and heaviness
- Very heavy periods
- Difficulty getting pregnant (1, 2, 8–12)
Why they happen
Uterine polyps occur when cells of the uterine lining (the endometrium) multiply too many times. As this happens, lumps are formed. These lumps often resemble hanging sacs or mushrooms made of tissue (14). Most are very small, but can range in size from a few millimeters, to several centimeters in diameter (15). Polyps can be numerous or few, and some people might only have one. Some research shows that estrogen plays an important role in the formation of polyps, but it’s not yet clear how (4).
Some people are more likely than others to develop uterine polyps. They are most common in people who are perimenopausal and postmenopausal. Obesity also makes people significantly more likely to develop polyps (4, 16, 17). Another contributing factor may be taking the breast cancer drug tamoxifen (18, 19).
Uterine polyps are similar to one type of uterine fibroids. Fibroids form from muscle tissue in the uterus, but can cause many of the same symptoms, as well as other ones. The biggest difference is that fibroids are more likely to be problematic in the reproductive years and shrink after menopause, while polyps are more likely to be problematic after menopause.
Why get them checked out?
Small uterine polyps are often asymptomatic, and can come and go on their own (2, 7). Some untreated polyps, however, may cause symptoms that affect quality of life and can lead to complications such as anemia (20). Anemia is a condition when the body doesn’t have enough healthy red blood cells to function properly. This can happen when uterine polyps cause a high amount of blood loss (21).
In rare cases, some uterine polyps carry a small chance of becoming cancerous (3, 8). They may also affect the ability to get or stay pregnant, but research on this topic is still lacking (9, 10).
How they’re diagnosed
A healthcare provider will probably ask questions about symptoms and medical and menstrual history and perform a simple physical exam. If they suspect you have uterine polyps, they may also perform:
- A transvaginal ultrasound
- A hysteroscopy: a small camera inserted into the uterus
- A biopsy: a small tool is inserted into the uterus to take a tissue sample
What you can do about them
Small uterine polyps can go away on their own without treatment (2, 7). If they do become problematic, there are a few different options treating existing polyps, and for preventing their future formation.
- Medications: Hormonal medications are sometimes prescribed to treat the symptoms of uterine polyps. These include Gonadotropin Releasing Hormone (GnRH) agonists, which block the body’s production of certain hormones progesterone, and progesterone, often prescribed in the form of a cream. These has been little research on the effectiveness of these hormonal treatments for uterine polyps (22).
- Non-invasive surgery: Small polyps can be removed with a process called hysteroscopic excision. About 7 in 10 people with small polyps ( <1cm) found their symptoms significantly improved after this procedure (1, 2, 11).
- Lifestyle Changes: Research on this is still unclear, but weight loss may improve the prognosis of people who are diagnosed with both uterine polyps and obesity (16, 23).
What to track
Essential to track:
- bleeding patterns
Helpful to to track:
- heaviness of bleeding
- sex (if trying to get pregnant)
Use Clue to track bleeding, pain, and other symptoms.