Uterine Polyps

Abstract

Polyps of the lower reproductive tract are found in 7.8–50% of women with abnormal uterine bleeding, infertility, and recurrent pregnancy loss. They can be hyperplastic, atrophic, or functional; they can be located in the uterine fundus, side walls, or cervix, and they are rarely associated with malignancy. Even though transvaginal ultrasound is the recommended initial imaging modality by all expert societies, it may not detect small intracavitary defects that could cause implantation failure, so there is a debate for routine hysteroscopy prior to in vitro fertilization in patients with normal transvaginal ultrasound. This chapter presents a thorough review of the literature regarding different imaging modalities employed for diagnosis of endometrial and cervical polyps and their impact on infertility and recurrent pregnancy loss. Current diagnostic parameters (endometrial thickness, vascularity, feeding vessel, echogenicity, interrupted mucosa sign) and guidelines for screening as well as for surveillance are presented. Special consideration to high-risk groups for recurrence (which could be as high as 43%) and even malignant transformation such as advanced age, menopausal status, obesity, diabetes, hypertension, breast cancer on tamoxifen, and hereditary cancers are discussed.