Endometrial polyps are hyperplastic overgrowths of glands and stroma that are localized and that form a projection above the surface. Such polyps may be sessile or pedunculated and rarely include foci of neoplastic growth.
The prevalence of polyps has been estimated at 10% to 24% among women undergoing endometrial biopsy or hysterectomy. Endometrial polyps are rare among women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age, peaks in the fifth decade of life, and gradually declines after menopause.
The most common symptom in women with endometrial polyps is metrorrhagia, or irregular bleeding; it is reported in 50% of symptomatic patients. Postmenstrual spotting is also common. Less common symptoms include menorrhagia, postmenopausal bleeding, and breakthrough bleeding during hormonal therapy. Overall, endometrial polyps account for 25% of abnormal bleeding in premenopausal and postmenopausal women (Van Bogaert, 1988).
Endometrial polyps can sometimes be seen prolapsing through the cervix. Often they are diagnosed by microscopic examination of a specimen obtained after dilatation and curettage (D & C) or after endometrial biopsy. As is the case with submucous fibroids, polyps can escape detection if the uterus is not distended. Increasingly these lesions are diagnosed by modalities such as ultrasonography and hysteroscopy.
Endometrial polyps usually are cured by thorough curettage. However, polyps or other structural abnormalities may be missed by blind curettage, and hysteroscopic-guided curettage is often useful.
Uterine anomalies may be congenital or they may be acquired after infection or mechanical trauma, and they may lead to reproductive or menstrual dysfunction.