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Gynecology (Expert Forum)
Unable to have endometrial polyp removed
Answered by
Elaine Brown, MD - Pregnancy, Gynecology
Elaine Brown, MD - BLOG
Billings - MT
Unable to have endometrial polyp removed
by LunaArt, Jan 14, 2009 10:27PM
I am 43 yrs old and am morbidly obese. In Mar 06 I started having spotting in between my menstrual cycles. After an ultrasound, I was diagnosed with an endometrial polyp and had a D&C and hysteroscopy in Aug 06 to remove it. The pathology report came back benign.
In Oct 08 I started having similar symptoms (cramping, irregular periods, occasional spotting between periods), so my gyn did an ultrasound and another polyp was found. In Dec 08, I had another D&C and hysteroscopy scheduled to remove the polyp. However, this time my gyn was unable to remove it. She told me the polyp is past the fundus and also my uterus is tilted, so she wasn’t able to reach the polyp with the first instrument. She tried to use a bigger, longer instrument but was unable to dilate my cervix enough to get the larger instrument through since I have never had children.
In my follow-up appt, my gyn says I only have a couple of options. The first one is to monitor the polyp with ultrasounds every 6 months and to also insert a Mirena IUD to thin out the lining to hopefully reduce the chances of getting another polyp and/or uterine cancer. She is also planning on doing an endometrial biopsy when she inserts the IUD since she was unable to do one during the surgery. Or, my other option would be to have a hysterectomy. She really wants to try the first option and only perform the hysterectomy as the very last resort.
My big concern is leaving the polyp and what that does to my chances of getting uterine cancer. Is having a biopsy without being able to test the polyp itself still good enough to detect if it is cancerous or not? My gyn also mentioned that the polyp may continue to grow and could possibly prolapse through the cervix. If it does that, will the polyp be able to be removed then?
I’m a bit scared of just leaving the polyp but I don’t want to have a hysterectomy if it is unnecessary either. Do you think the best option is to leave it alone and just monitor it for now?
Thanks, Lisa
In Oct 08 I started having similar symptoms (cramping, irregular periods, occasional spotting between periods), so my gyn did an ultrasound and another polyp was found. In Dec 08, I had another D&C and hysteroscopy scheduled to remove the polyp. However, this time my gyn was unable to remove it. She told me the polyp is past the fundus and also my uterus is tilted, so she wasn’t able to reach the polyp with the first instrument. She tried to use a bigger, longer instrument but was unable to dilate my cervix enough to get the larger instrument through since I have never had children.
In my follow-up appt, my gyn says I only have a couple of options. The first one is to monitor the polyp with ultrasounds every 6 months and to also insert a Mirena IUD to thin out the lining to hopefully reduce the chances of getting another polyp and/or uterine cancer. She is also planning on doing an endometrial biopsy when she inserts the IUD since she was unable to do one during the surgery. Or, my other option would be to have a hysterectomy. She really wants to try the first option and only perform the hysterectomy as the very last resort.
My big concern is leaving the polyp and what that does to my chances of getting uterine cancer. Is having a biopsy without being able to test the polyp itself still good enough to detect if it is cancerous or not? My gyn also mentioned that the polyp may continue to grow and could possibly prolapse through the cervix. If it does that, will the polyp be able to be removed then?
I’m a bit scared of just leaving the polyp but I don’t want to have a hysterectomy if it is unnecessary either. Do you think the best option is to leave it alone and just monitor it for now?
Thanks, Lisa
Doctor's Answer
by Elaine Brown, MD, Jan 15, 2009 09:37PM
, Jan 15, 2009 09:37PMTo: LunaArt
Hi!
Lots of good questions. My response may be a bit slanted by the fact that I have personally had a pre-malignant polyp removed from my uterus. As you are probably aware, these polyps may be caused by chronic high estrogen levels in the body. The problem with polyps is that because the circulation to them is poor, they are not subject to the same careful cancer surveillance by the body's immune system as normal tissues, and are therefore more apt to develop malignancy. They are an abnormal growth in the first place which also makes them high risk.
I would personally want the polyp removed and biopsied. Could another doctor try a hysteroscopy? I realize that is another surgery. You may want to also consider the future. The extra weight you are carrying is the source of the estrogen that is causing these polyps to develop, and so, unless that changes, you are going to have this problem indefinitely. Even after menopause--and it may actually get worse then because there will be no progesterone at all to counter act the estrogen.
I guess what I am saying is that even though your potential risk with major surgery is nothing to sneeze at, unless you want your uterus for child-bearing, you may want to strongly consider the hysterectomy. Your surgical risk doesn;t get any better with age!
As you know, the best option would be to lose the weight. Have you researched the laparoscopic band procedure? I don't know if they could combine a lap band/ lap assisted hysterectomy for you, and minimize your anesthetic risk!
The Mirena MIGHT work. An endometrial biopsy is PRETTY GOOD (but it is done blindly and can miss the polyp altogether). If the polyp prolapses, you might be able to extract part of it, but they are very fragile, and it would be very likely to break into lots of pieces leaving the concern for re-growth if part is left behind,
Gynecologic Oncologists have 2- 3 extra years of surgical training and are much more comfortable with the extra surgical risk associated with obesity. If you were my patient, unless you wanted babies, I would get my favorite gyn/onc expert to assist me with your laparoscopic vaginal hysterectomy.
I hope this is helpful!
Dr B
Lots of good questions. My response may be a bit slanted by the fact that I have personally had a pre-malignant polyp removed from my uterus. As you are probably aware, these polyps may be caused by chronic high estrogen levels in the body. The problem with polyps is that because the circulation to them is poor, they are not subject to the same careful cancer surveillance by the body's immune system as normal tissues, and are therefore more apt to develop malignancy. They are an abnormal growth in the first place which also makes them high risk.
I would personally want the polyp removed and biopsied. Could another doctor try a hysteroscopy? I realize that is another surgery. You may want to also consider the future. The extra weight you are carrying is the source of the estrogen that is causing these polyps to develop, and so, unless that changes, you are going to have this problem indefinitely. Even after menopause--and it may actually get worse then because there will be no progesterone at all to counter act the estrogen.
I guess what I am saying is that even though your potential risk with major surgery is nothing to sneeze at, unless you want your uterus for child-bearing, you may want to strongly consider the hysterectomy. Your surgical risk doesn;t get any better with age!
As you know, the best option would be to lose the weight. Have you researched the laparoscopic band procedure? I don't know if they could combine a lap band/ lap assisted hysterectomy for you, and minimize your anesthetic risk!
The Mirena MIGHT work. An endometrial biopsy is PRETTY GOOD (but it is done blindly and can miss the polyp altogether). If the polyp prolapses, you might be able to extract part of it, but they are very fragile, and it would be very likely to break into lots of pieces leaving the concern for re-growth if part is left behind,
Gynecologic Oncologists have 2- 3 extra years of surgical training and are much more comfortable with the extra surgical risk associated with obesity. If you were my patient, unless you wanted babies, I would get my favorite gyn/onc expert to assist me with your laparoscopic vaginal hysterectomy.
I hope this is helpful!
Dr B
Anyway, thanks again for your help!!
Lisa