Ask Dr. H: Benefits of removing uterine polyps

Question:

How serious are uterine polyps? I just had a sonogram of my uterus that found I have two polyps. My gynecologist now has me scheduled for a D&C procedure to remove them.

Answer: While the uterus is mostly muscle, its inner lining is made of hormonally influenced endometrial tissue that grows and sheds with each menstrual cycle. Polyps are uterine tissue that grow a bit too much in response to hormones like estrogen and fail to slough off with menstruation.

Polyps generally cause no symptoms and conventional teaching has been that they are almost always benign and noncancerous. However, a recent review and analysis of 17 studies that involved 10,572 women who underwent a procedure for uterine polyp removal found that 3.6 percent of the polyps were cancerous.

Women with abnormal uterine bleeding were almost twice as likely as nonsymptomatic women to have cancerous uterine polyps. Neither obesity nor polyp size was consistently associated with cancer risk.

Removal of uterine polyps is typically done under general anesthesia by looking at the polyps through hysteroscopy and then scraping (curettage) or cutting them away. The tissue is sent off to the pathology lab to be sure it's benign. The presence of uterine polyps can be one cause of infertility and miscarriage, so a potential benefit of their removal may be the restoration of fertility.

Q: In your opinion, could Ambassador Richard Holbrooke's death from a ruptured aorta have been prevented by detecting it before it was too late?

A: From what I've heard from news reports, Mr. Holbrooke had no warning symptoms until it was too late. It appears that he died when the thoracic section of the aorta, the main artery carrying blood from the heart to the rest of the body, ruptured as its lining dissected apart.

If a rupture occurs slowly, there will be terrific chest pain mimicking a heart attack that might lead to, among other interventions, a prompt chest X-ray. It should show the image of a widened aorta. Immediate action to lower blood pressure and take the patient to surgery could prevent a fatal aortic rupture.

If the rupture occurs suddenly and quickly, the bleeding is massive and the prognosis is extremely poor. Mr. Holbrooke underwent 27 hours of emergency surgery over two days, but his vital organs, severely oxygen-deprived from massive blood loss and shock, were unable to recover.

Fortunately, a thoracic aortic wall dissection and rupture is rare. I don't have any information about his medical or family history, but generally speaking, the biggest risk factors are: long-standing high blood pressure that is poorly controlled; atherosclerosis (cholesterol plaque in arteries); trauma history such as a motor-vehicle or sports injury; and inherited connective-tissue defects such as Marfan's syndrome.