Over time women may develop common gynaecological conditions such as fibroids, cysts, and polyps because of hormonal changes, the menstrual cycle, and other lifestyle factors. But with the three being so similar, you may find it difficult to differentiate between them.
Many women confuse cysts, fibroids and polyps. And while they are similar, there are key differences between the three. Let’s take a look at the differences:
Endometrial Polyps are soft overgrowths that project from the surface of the endometrium, the mucous membrane lining the uterus. Most endometrial polyps, also known as uterine polyps, are benign. However, some can be cancerous. According to one study, approximately 95 percent of endometrial polyps are benign. In general, endometrial polyps are more commonly found in older, postmenopausal women. This is because women of reproductive age regularly shed the endometrium during menstruation, while menopausal women do not. In one systematic review including over 10,000 women, the incidence of malignant and pre-cancerous polyps was significantly higher in postmenopausal compared to premenopausal women.
There is limited information regarding the effects of endometrial polyps on fertility. In the few studies that have been published, it was found that endometrial polyps do not significantly increase the risk of adverse obstetric outcomes. In one study, the prevalence of uterine polyps was the same in women with a recent miscarriage as it was in the general population.
Endometrial Polyps Symptoms
Not all uterine polyps will cause symptoms. However, the most common symptom of endometrial polyps is abnormal uterine bleeding. This includes:
• Heavy bleeding between menstrual periods (intermenstrual bleeding)
• Bleeding post-menopause
• Vaginal bleeding after physical activity or sexual intercourse
• Heavy bleeding during menstruation
The presence of an endometrial polyp is confirmed with pelvic ultrasound imaging or hysteroscopy, a procedure that involves inserting a thin, lighted tube with a camera into the vagina to examine the inside of the uterus. If the polyp is concerning for possible cancer, your OB-GYN will perform an endometrial biopsy to check for cancer or precancerous cells.
Endometrial Polyp Treatment
Symptomatic endometrial polyps are more likely to be malignant and precancerous. Therefore, they should be removed in premenopausal and postmenopausal women. This is usually done through a polypectomy procedure under hysteroscopic guidance, where small surgical instruments are inserted through a thin and lighted tube to remove the polyp.
Women with asymptomatic uterine polyps may benefit from polyp removal if they have additional risk factors that increase their chances of developing endometrial cancer. However, most asymptomatic endometrial polyps are managed with watchful waiting to see if they will resolve on their own over time.
Uterine fibroids, which are also called leiomyomas or myomas, are benign (noncancerous) muscular growths within the walls of the uterus. In fewer than 1 in 1,000 cases, what was thought to be a uterine fibroid may be a cancerous mass. They range in size from ¾ inch to several inches in diameter. Up to 70 percent of white women and between 80 to 90 percent of women by age 50. They often do not cause any symptoms and are frequently detected incidentally during a routine examination.
Symptoms of uterine fibroids:
Fibroids often cause heavy and painful periods, abnormal uterine bleeding, and pelvic pain and pressure in patients. In addition to discomfort, fibroids may also cause pregnancy complications and/or infertility. Symptoms of uterine fibroids include:
• Changes in the menstrual cycle including heavy or prolonged bleeding
• Abdominal and pelvic cramping
• Lower back pain
• Pain or pressure during intercourse
• Frequent or difficult urination
• Recurrent miscarriages
If fibroids are suspected or discovered in a routine pelvic exam, an OB-GYN will first aim to fully assess their size, number and position. This can be done using a variety of imaging methods including ultrasound and hysteroscopy (a thin tube with a camera inserted through the vagina to examine the uterus).
More advanced imaging techniques such as magnetic resonance imaging (MRI) scans and computerized tomography (CT) scans may be ordered in more complex cases.
Uterine fibroids treatment:
Determining the appropriate treatment for fibroids depends on several variables including severity and type of symptoms, to what degree the fibroids are affecting the body’s ability to function normally, and whether or not a woman wishes to get pregnant in the future.
Over-the-counter pain medication can sometimes relieve uterine fibroid symptoms. Hormonal medications, including certain birth control medications, can be very effective in reducing the pain and heavy bleeding caused by fibroids, provided the woman does not wish to become pregnant.
Women who are actively trying to get pregnant or wish to preserve their future reproductive options may opt to have fibroids surgically removed while leaving the uterus intact. Surgical removal of the fibroids alone is called a myomectomy.
Other options for fibroid removal include uterine artery embolization (UAE), a procedure that eliminates blood vessels that supply the fibroids, and MRI-focused ultrasound therapy that is a nonsurgical technique using high-intensity ultrasound waves to destroy fibroids. Pregnancy is not recommended after these procedures.
A hysterectomy will provide definitive treatment. This is the surgical removal of the uterus and can be performed in various degrees and with different surgical approaches.
Ovarian cysts are fluid-filled sacs that can develop in or on either ovary. They are commonly found in pre-menopausal women and are usually benign. Cancer is the cause of ovarian cysts in less than 1 in 100 cases.
In most cases, an ovarian cyst forms when a follicle on an ovary responsible for releasing an egg fails to open during ovulation. This being the case, many reproductive-aged, pre-menopausal women can develop an ovarian cyst. On the other hand, ovarian cysts are a lot less common in post-menopausal women.
Ovarian cysts can be a natural part of ovulation, and most cysts resolve on their own in a few months without any intervention. However, ovarian cysts can be worrisome if they demonstrate the potential to rupture or cause the ovary to twist on itself (ovarian torsion). If the ovarian cyst is abnormally large, appears complex with solid areas or nodules on the surface, and you have a family history of ovarian or other types of cancer, this may also increase the concern for possible malignancy.
In polycystic ovary syndrome (PCOS), many small cysts form on the ovaries. Infertility is common in patients with PCOS. Pelvic ultrasound is a sensitive method for detecting ovarian cysts.
Ovarian Cyst Symptoms:
Often, ovarian cysts will cause no symptoms at all. However, if symptomatic, ovarian cysts may produce:
• Lower abdominal pain or pelvic pressure
• Sudden and severe sharp pain immediately after sexual intercourse mid-menstrual cycle
• Sudden and severe sharp pain if an ovarian cyst bursts
•Nausea or vomiting along with pain if the cyst causes ovarian torsion
Ovarian Cyst Removal:
Ovarian cysts in premenopausal women usually resolve on their own without treatment, and few cause complications as severe as ovarian torsion, significant rupture, or cancer. Your OB-GYN may recommend watchful waiting with periodic pelvic ultrasounds.
If your ovarian cyst continues to cause persistent pelvic pain, is suspicious for cancer or is at risk of rupturing or causing ovarian torsion, your healthcare provider may recommend surgery to remove the cyst. The surgical removal of an ovarian cyst is called a cystectomy. During this procedure, the ovaries are kept intact.
Fibroids and cysts are both common, particularly before menopause. The big difference between the two is that fibroids first develop in the muscular lining of the uterus, while cysts form in or on the ovaries. They don’t always produce symptoms and are usually benign, so you don’t always need to treat them. When they do cause severe symptoms, there are safe and effective treatments. You can choose a treatment based on your personal preferences and if you want to get pregnant in the future.
It is important to consult with your specialist if you are experiencing symptoms like bloating, pelvic pain, and heavy periods. It’s crucial to find out if you have uterine fibroids, ovarian cysts, endometrial polyps, or in some cases some other treatable condition.