Uterine Fibroids and Polyps
Many women have uterine fibroids and polyps, which are typically benign tumors. These growths don’t always cause symptoms, nor do they necessarily signal immediate health threats. But if you experience cramping and bleeding after menopause, you should discuss these symptoms with your gynecologist.
“Fibroids and endometrial polyps are two of the most common causes of abnormal genital tract bleeding in both premenopausal and postmenopausal women,” says Christopher Tarnay, MD, co-director of the UCLA Fibroid Treatment Program and associate professor of obstetrics and gynecology. “Among clinically symptomatic polyps, the prevalence appears to increase steadily with age and is higher in postmenopausal compared with premenopausal women.”
Polyps vs. Fibroids
While both these growths occur in the uterus, they derive from different types of tissue. Uterine fibroids (also known as myomas) are made of smooth muscle cells and fibrous connective tissue. Polyps result from an overgrowth of endometrial cells in the lining of the uterus. These cells normally shed during menstruation but sometimes develop into polyps. Like fibroids, polyps may resolve on their own without treatment.
They key difference in these growths is that fibroids tend to shrink post- menopause, whereas polyps have a greater tendency to develop and grow after menopause. Persistent polyps have a potential to become cancerous.
Physicians may refer to polyps as endometrial or uterine polyps. They can be as small as a sesame seed or grow to be golf-ball-sized or larger. Sometimes they can grow so large that they drop through the cervix into the vagina and may even extend out of it.
Though fibroids are more common in premenopausal women, postmenopausal women may get these growths, too. “When they are large, fibroids can push on the bladder and cause urinary urgency or frequency,” says Dr. Tarnay. “In general, fibroids begin to shrink after menopause (no more hormone stimulation) and subsequently they rarely contribute to any symptoms. Watching and waiting is certainly appropriate for fibroids that are not causing symptoms. However, if large and symptomatic, there are a variety of minimally invasive and other options available.”
Hormonal factors appear to play a role in the development of both polyps and fibroids. With declining estrogen and progesterone, fibroids are less common. However, postmenopausal women who partake of hormone replacement therapy have a greater risk for these growths due to ongoing hormone treatments.
Troublesome Fibroids
Women with symptomatic fibroids may experience frequent urination, pain with intercourse, and low back pain and pressure. These masses can be felt during a pelvic exam, and the diagnosis is confirmed with a scan, usually an ultrasound. Cancerous fibroids are very rare. In cases requiring treatment to abate symptoms, there are several minimally invasive options. UCLA has a comprehensive treatment program that includes uterine artery embolization, a minimally-invasive procedure that cuts off the blood supply to the fibroids. Endometrial ablation uses heat or extreme cold to destroy the mass.
Problematic Polyps
Unlike colon polyps, the vast majority of endometrial polyps are benign (not cancerous). Risk factors for these growths include obesity, high blood pressure, and elevated glucose levels. Risk also increases for women with breast cancer who are on tamoxifen therapy. In a randomized trial with over 9,400 postmenopausal patients with breast cancer treated with chemotherapy, the incidence of polyps was higher in women treated with tamoxifen compared with raloxifene (2.1% versus 0.6%) over the 81-month trial period, according to a study published in the American Journal of Obstetrics and Gynecology. Diagnosing for the presense of polyps is similar to that of fibroids.
“When abnormal vaginal bleeding occurs, ultrasound and endometrial assessment can be done to evaluate for the presence of endometrial polyps,” explains Dr. Tarnay. “Compared with premenopausal women, endometrial polyps occurring in postmenopausal women have about four times greater risk of being cancerous, particularly if abnormal uterine bleeding is also present.”
Dr. Tarnay stresses that for endometrial polyps the only instance where watch and wait is acceptable is when these growths are found incidentally and there is no abnormal vaginal bleeding. Due to the increased cancer risk in postmenopausal women, he recommends a biopsy even in asymptomatic women. Endometrial cancer is the most common cancer of the female reproductive organs, according to the American Cancer Society. It affects mainly postmenopausal women. The average age of diagnosis is 60. 
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