What is Cervical Polyps?
Cervical polyps are non-cancerous growths that usually stick out from the surface of the opening to the uterus, known as the cervical canal. These growths are more common in women who can still have children, especially after they turn 20.
Cervical polyps come in a variety of sizes, shapes, and come from different origins. They can be alone or in groups, be tear-shaped or round, and their colors can range from cherry red to a greyish white. This difference in color depends on how much blood supply the growth has. The size of the cervical polyp is typically smaller than three cm in diameter. However, polyps can still come in different sizes, and some can be large enough to fill the vagina or be present at the entrance of the vagina. From a structure point of view, a cervical polyp is connected to the surface by a stalk-like structure, which can be long and thin, or short and wide.
Although cervical polyps are usually non-cancerous, in 0.2 to 1.5% of cases, they can be cancerous. These cancerous polyps are more likely to be seen in patients who have gone through menopause.
Cervical polyps are grouped based on where they came from. There are two types: ectocervical and endocervical polyps.
1. Endocervical polyps are the most common type and usually are seen in women who have not gone through menopause. They typically start from the glands in the inner lining of the cervix, known as the endocervix.
2. Ectocervical polyps are more common in women who have gone through menopause and start from the outer surface layer cells of the cervix, within the ectocervix.
What Causes Cervical Polyps?
The exact cause of cervical polyps, which are growths on the narrow canal connecting the uterus and vagina, is still a mystery. But there are a few theories that might explain why they happen.
One theory proposes that they could be caused by a build-up of blood in the cervix, disrupting the normal blood flow and leading to the development of polyps.
Another theory suggests cervical polyps could be due to an infection or long-term inflammation of the cervix. In some cases, chemicals that irritate the cervix over a long period of time can result in abnormal cell changes.
Finally, another theory suggests that an unusual response to increased estrogen levels could lead to these growths. This excessive growth of cervical tissue may be linked to endometrial hyperplasia, a condition where the lining of the uterus becomes too thick.
There are also specific risk factors that increase the chance of developing cervical polyps. These include:
- Being a woman in the years before menopause
- Having been pregnant multiple times
- Having sexually transmitted infections
- Having a history of cervical polyps
Risk Factors and Frequency for Cervical Polyps
Cervical polyps are a common issue seen by gynecologists, and they are the second most commonly found polyps during gynecological examinations, coming after endometrial polyps. In general, between 2 to 5 percent of women have cervical polyps. Those who have given birth multiple times are more likely to develop them compared to women who have not given birth. Also, one in every eight women will get a cervical polyp again even after it has been removed once.
It used to be difficult to find polyps during routine gynecological examinations because they usually don’t show any symptoms and also due to the limitations of the technologies that were available before, including ultrasound and hysteroscopy. But now, newer technologies make it easier for doctors to identify and locate these polyps, leading to better results for patients.
Signs and Symptoms of Cervical Polyps
Cervical polyps are often found by chance during routine gynecologic check-ups, or while using special procedures like colposcopy, or ultrasound scans of the abdomen or vagina. Two-thirds of women with cervical polyps don’t experience any symptoms. However, those who do have symptoms usually experience abnormal bleeding from the uterus. This could include unusually heavy periods, bleeding between periods, or bleeding after menopause. They may also have vaginal discharge.
In rare cases, a large polyp can block the cervical canal, leading to problems with fertility. During a medical check-up, a doctor can often see a growth inside the cervix, indicating the presence of a polyp.
Testing for Cervical Polyps
In order to conclusively determine if someone has cervical polyps, doctors use a microscopic tissue examination. This lets them examine the structure of the cells and tissues in your body on a minute scale. But it’s also important to check for any other potential health issues that might be connected with the polyps. This is why doctors may use several tests:
1. The first is a triple smear, also known as a vaginal-cervical-endocervical (VCE) smear. This is a test that collects cells from your vagina, cervix, and inner cervix to be observed under a microscope for any abnormalities.
2. The second is a transvaginal ultrasound. An ultrasound creates pictures of the inside of your body using sound waves. In this case, the ultrasound is used to check for any problems with the endometrium, which is the lining of the uterus. If the ultrasound does show any potential issues, doctors should take a small tissue sample from the endometrium for further testing.
Treatment Options for Cervical Polyps
The way cervical polyps are treated largely depends on their size, shape and whether or not they cause symptoms. Polyps that don’t cause any symptoms, are small in size and appear normal usually don’t need any treatment. However, if they are large, cause symptoms or appear atypical, they usually need to be removed.
There are various techniques for removing polyps. For those on slender stalks, the base is grasped with a special tool (ring forceps) and it’s twisted until it comes off. Smaller polyps can be removed using a tool called a punch biopsy forceps. If the polyp is on a thick stalk, it usually needs to be removed using an electrical tool or a tool used for viewing the inside of the uterus (hysteroscope).
After the polyps are removed, the base where the polyps used to be can be sealed using heat (cauterized) to prevent bleeding and make it less likely for the polyps to come back. If the base is very wide, it can be treated using an electrical tool or laser.
Every removed polyp should be looked at under a microscope to check for cancer. This is particularly important for women who have had polyps come back and for women who have gone through menopause. They should also have the inside of their uterus examined using a hysteroscope, looking for any problems in their uterine cavity, such as more polyps or cancer. This is important because up to a quarter of women with cervical polyps also have polyps inside their uterus. Among women with any kind of issue in their uterus, around 11% of those who have gone through menopause and about 8% of those who haven’t have cervical polyps.
Some of the mentioned procedures don’t allow the doctor to see everything clearly. This can make it hard to spot all polyps or to determine their exact size, location and origin. If parts of polyps are left in the cervix, they could grow back.
Cervical polyps in pregnant women are rare and usually don’t cause symptoms and are small. Sometimes they are mistaken for signs of a threatened miscarriage in early pregnancy by causing unexplained vaginal bleeding. Therefore, if pregnant women experience unexplained bleeding, it’s recommended that they have an ultrasound using color feature (color doppler ultrasound) to check for cervical polyps and other possible issues, such as abnormal blood vessels (vasa previa).
After childbirth, bleeding from the place where the polyp was can be a serious issue because polyps have large blood vessels (are vascular). Another serious issue with cervical polyps is that they could turn into cancer. In fact, some studies showed that 5% of women with symptoms had polyps that were precancerous or already cancer. So, it’s important that removed polyps are studied under a microscope.
There’s no agreement on how to treat cervical polyps in pregnant women. Some studies suggest removing them during pregnancy using a cold treatment (cryosurgery). However, some prefer not to treat to prevent heavy bleeding, premature delivery or miscarriage.
Rarely, cervical polyps can cause issues with the cervix shortening or opening too early in pregnancy (funneling). In one case, a pregnant woman experienced premature contractions and bleeding due to a large cervical polyp causing funneling and shortening of the cervix. It was successfully removed when she was 38 weeks pregnant without any issues.
If a woman is not able to get pregnant (infertile) and also has cervical polyps, removing them using a hysteroscope may help increase her chances of getting pregnant. This is assuming there aren’t any other causes for infertility. Polyps that are left untreated may continue to grow, causing infertility. They could also turn into a precancerous condition.
What else can Cervical Polyps be?
When trying to diagnose cervical polyps, doctors look out for certain symptoms in patients, the most common one being abnormal bleeding from the uterus. This kind of bleeding can happen because of many reasons, including the following:
- Uterine fibroid
- Overgrowth and cancer of the lining of the uterus (endometrial hyperplasia and malignancy)
- Endometriosis (a condition where tissue similar to the lining of the uterus grows outside the uterus)
- Adenomyosis (when the inner lining of the uterus breaks through the muscle wall of the uterus)
- Cervical ectropion (when the cells lining the inside of the cervical canal spread to the outer surface of the cervix)
- Cervical cancer
- Surface lesions of the genital tract
- Sexually transmitted infections
- Conditions related to pregnancy, like ectopic pregnancy (a pregnancy that occurs outside the uterus)
- During a gynecological examination, a polyp that comes from the lining of the uterus and goes through the cervical canal may look like a cervical polyp if it’s in the cervix
What to expect with Cervical Polyps
As previously discussed, most cervical polyps are not harmful, although there is a small chance of them being harmful in about 0.2 to 1.5% of the cases. Removing cervical polyps is a straightforward process that typically involves only minor complications. It’s important to note that women who have had polyps in the past are at risk of having them again.
Possible Complications When Diagnosed with Cervical Polyps
The primary issue with a polyp is that it can cause infertility if it grows large enough to block the external opening of the cervix. Additionally, these polyps can get inflamed or infected, causing a yellowish vaginal discharge.
The removal of a polyp, known as a polypectomy, can also have some risks, such as:
- Infection
- Excessive bleeding
- Piercing of the uterus. To lower this risk, only easily visible polyps should be removed in a clinic. Doctors shouldn’t blindly try to remove polyps located within the cervical canal or uterus itself.
Preventing Cervical Polyps
There aren’t any proven ways to prevent cervical polyps from occurring, but they can be successfully treated. A common procedure for removing them is called hysteroscopic removal. This is considered the best form of treatment and typically results in high levels of success and patient satisfaction.
Cervical polyps can be somewhat difficult to understand because their nature is highly ambiguous. However, it’s comforting to know they don’t ordinarily pose a serious health risk. In fact, only a small fraction of these polyps can turn into cancer.