Should You Remove Uterine Polyps? A Guide for Women Over 40

Do uterine polyps always need to be removed?

Hello Doctor, I am 48 years old and no longer wish to conceive.
Last May, a transvaginal ultrasound revealed a 1.9 cm polyp in my uterus.
At that time, the doctor at the first regional hospital advised me to wait for a few menstrual cycles before returning for a follow-up.
However, I tend to be impatient, so I went to a second large teaching hospital that same month for a hysteroscopy.
The doctor there said that I could just continue to monitor it.

A year has passed, and last week I returned to the first regional hospital for follow-up.
This time the polyp measured 1.3 cm, but the doctor recommended that I have it removed to avoid potential complications.
I am quite troubled and would like to hear your advice.
So far, I have not experienced any bleeding symptoms between periods or after sexual intercourse.
However, since last October, my menstrual cycles have become irregular.
I have taken medication to induce menstruation twice; I had normal cycles from October to January, but did not have a period in February and March.
After taking the medication, my period returned.
I suspect this is likely due to my age.
I have read that others often opt for removal due to symptoms or fertility concerns, but I would prefer to just monitor it annually.
I am also worried about what the doctor at the first hospital mentioned regarding potential changes after menopause.
Should I have the polyp removed? I apologize for the trouble, and thank you.

jujube, 40~49 year old female. Ask Date: 2018/04/13

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the presence of endometrial polyps typically warrants surgical intervention if there are symptoms or concerns about potential malignancy.
If there are no such reasons and the patient is psychologically comfortable, monitoring and observation are acceptable.
Physicians cannot determine future changes based solely on ultrasound; it is usually a matter of probability.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2018/04/13

More Info

When considering whether to remove uterine polyps, especially for women over 40, several factors must be taken into account, including the size of the polyp, any associated symptoms, and individual health circumstances. In your case, you have a 1.9 cm polyp that has since reduced to 1.3 cm, and you have not experienced any abnormal bleeding or other symptoms. However, your menstrual cycle has become irregular, which is not uncommon as women approach menopause.

Uterine polyps are growths on the lining of the uterus that can vary in size and number. While many polyps are benign and may not cause any issues, they can sometimes lead to complications, such as abnormal bleeding or infertility. In women over 40, the risk of polyps being associated with more serious conditions, including endometrial cancer, increases. Therefore, monitoring and management become crucial.

The recommendation to remove a polyp often depends on its characteristics and the patient's overall health. If a polyp is larger than 1 cm, especially in women over 40, many healthcare providers recommend removal to rule out any potential malignancy, even if the patient is asymptomatic. The rationale is that while many polyps are benign, there is a small risk that they could harbor precancerous changes, particularly in postmenopausal women.

In your situation, since you have been advised by two different medical professionals to monitor the polyp, it may be beneficial to consider their recommendations carefully. The first doctor suggested observation, which is a valid approach, especially if there are no symptoms. However, the second doctor’s advice to remove the polyp to avoid future complications is also reasonable, particularly given your age and the changes in your menstrual cycle.

If you are leaning towards observation, it is essential to have regular follow-ups, including ultrasounds, to monitor any changes in the polyp's size or characteristics. If you choose to have the polyp removed, the procedure is typically straightforward and can often be done as an outpatient procedure. This would provide peace of mind and allow for a definitive diagnosis through histological examination of the polyp tissue.

Regarding your irregular menstrual cycles, this can be a normal part of the perimenopausal transition. Hormonal fluctuations during this time can lead to changes in the frequency and heaviness of menstrual periods. If you have concerns about your menstrual irregularities, discussing them with your healthcare provider can help determine if any further evaluation or treatment is necessary.

In conclusion, the decision to remove uterine polyps should be made based on a thorough discussion with your healthcare provider, considering your personal health history, the characteristics of the polyp, and your current symptoms. If you feel uncertain, seeking a third opinion from a gynecologist who specializes in reproductive health may provide additional clarity and reassurance. Ultimately, the goal is to ensure your health and well-being as you navigate this stage of life.

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