Closed Polyp Surgery

Intrauterine Polyp Surgery (Hysteroscopy)

Benign fleshy growths that arise from the endometrium — the layer lining the inside of the uterus — usually finger-shaped or sometimes broader-based, are called intrauterine polyps (endometrial polyps). Polyps are fairly common findings in women, and their size can range from a few millimeters to a few centimeters. There may be one or more polyps in the uterus. Most polyps cause no symptoms and are found incidentally. However, some polyps — particularly as they grow larger or depending on their location — can cause abnormal uterine bleeding (such as intermenstrual bleeding, heavy menstrual bleeding, or postmenopausal bleeding) or infertility. Although the risk of polyps turning into cancer is quite low (less than 1-5%, with the risk being somewhat higher in postmenopausal women and those with bleeding complaints), it is important to remove and pathologically examine polyps that cause symptoms or appear suspicious. Today, the gold-standard method for both diagnosing and treating intrauterine polyps is hysteroscopy, also known as closed polyp surgery. This minimally invasive method allows the polyps to be fully removed under direct visualization of the uterine cavity, without any incision in the abdomen, and offers patients a rapid recovery. At her clinic in Ankara, Prof. Dr. Nuray Bozkurt offers her patients a reliable treatment option with her experience in hysteroscopic polypectomy.

What Is an Intrauterine Polyp (Endometrial Polyp)? Why Does It Occur?

Endometrial polyps are fleshy growths, usually extending into the uterine cavity, that form as a result of the excessive growth of the endometrial glands and stroma (supporting tissue) making up the uterine lining; they may be pedunculated (stalked) or sessile (broad-based). Their structure can be spongy, and they contain blood vessels.

Although the exact cause of polyps is not fully known, hormonal factors — particularly estrogen — are thought to play a role. Estrogen’s thickening effect on the uterine lining can trigger polyp growth. For this reason, polyps are seen more frequently during the reproductive years and especially during the transition to menopause (perimenopause). Other risk factors include:

  • Age: Incidence increases in the 40s and 50s.
  • Obesity: Estrogen production from fat tissue increases.
  • Hypertension.
  • Tamoxifen Use: This medication, used in breast cancer treatment, can increase the risk of polyps.
  • Hormone Replacement Therapy (HRT).
  • Certain genetic conditions such as Lynch Syndrome.

The vast majority of polyps (95-99%) are benign. The risk of malignant transformation is low, but this risk should not be overlooked — particularly in polyps causing bleeding in the postmenopausal period or when there is a suspicious appearance on ultrasound — and every removed polyp must be sent for pathological examination.

What Are the Symptoms of Intrauterine Polyps? When Should You Suspect Them?

A significant portion of polyps cause no symptoms at all and are found incidentally during a routine gynecological check-up or an ultrasound performed for another reason. When symptoms do occur, the most common complaint is abnormal vaginal bleeding:

  • Intermenstrual Bleeding or Spotting: This is the most common symptom.
  • Heavy (Menorrhagia) or Prolonged (Hypermenorrhea) Menstrual Bleeding.
  • Irregular Menstrual Bleeding.
  • Bleeding After Intercourse (Postcoital Bleeding): Rarely seen.
  • Postmenopausal Bleeding: Any vaginal bleeding in a woman who has entered menopause must always be investigated for the possibility of a polyp.

Less commonly seen symptoms include:

  • Infertility: Polyps are thought to hinder embryo implantation into the uterus by occupying space within the uterine cavity or by causing inflammation. Finding a polyp in women undergoing infertility work-up is not uncommon.
  • Recurrent Miscarriages: Although rare, they can cause recurrent pregnancy loss.
  • Vaginal Discharge: Can be seen especially with large or infected polyps.
  • Mild Pain or Cramping: Generally rare.

If you have complaints such as abnormal vaginal bleeding or infertility, or if a polyp is suspected on ultrasound, it is important to consult your doctor for further evaluation.

How Is an Intrauterine Polyp Diagnosed?

Various methods are used in the diagnosis of intrauterine polyps:

  • Transvaginal Ultrasonography (TVUS): This is usually the first examination performed. It may appear as thickening of the uterine lining (endometrium) or as a well-defined mass (polypoid lesion) extending into the uterine cavity. However, especially small polyps can be missed on ultrasound or confused with submucosal myomas. Doppler ultrasound can show the feeding vessel inside the polyp.
  • Saline Infusion Sonohysterography (SIS), or Fluid Ultrasound: This involves distending the uterine cavity with sterile saline solution and performing an ultrasound at the same time. This method shows the presence, location, size, and stalk of intrauterine polyps much more clearly and makes it easier to distinguish them from myomas. It is a highly sensitive method for diagnosing polyps.
  • Hysteroscopy: This involves entering the uterine cavity with a thin camera to directly visualize it. It is considered the gold standard for diagnosing polyps. The doctor clearly sees the location, size, number, and appearance of the polyp. Its greatest advantage is that it allows any polyps detected during diagnosis to be removed in the same session (hysteroscopic polypectomy).
  • Endometrial Biopsy: An office-based blind biopsy (Pipelle biopsy) may incidentally capture polyp tissue, but the chance of missing the polyp is high. For a definitive diagnosis, the polyp itself must be removed and examined. However, it may be performed in patients with abnormal bleeding to rule out accompanying conditions such as hyperplasia or cancer.

Why and How Is Closed Polyp Surgery (Hysteroscopic Polypectomy) Performed?

The removal of intrauterine polyps is called polypectomy, and today this procedure is largely performed via hysteroscopy, that is, using the closed method.

Why Is Hysteroscopic Polypectomy Performed? (Indications):

  • Symptomatic Polyps: Polyps causing complaints such as abnormal bleeding (intermenstrual, heavy menstrual, postmenopausal, etc.) or pain need to be removed.
  • Polyps Detected in Cases of Infertility: Regardless of size, polyps found in women with infertility are generally recommended for removal, as they are thought to negatively affect embryo implantation. Polypectomy may also be performed before IVF treatment in order to clear the uterine cavity.
  • Polyps Thought to Cause Recurrent Miscarriages:
  • All Polyps Detected After Menopause: Due to the risk of cancer (even if low), it is generally recommended that all polyps detected after menopause be removed and examined pathologically.
  • Large-Sized Polyps: Removal may be considered for polyps generally larger than 1.5-2 cm, due to their potential to cause symptoms or, rarely, undergo malignant transformation.
  • Polyps Suspicious for Cancer: Polyps that appear suspicious on ultrasound or hysteroscopy need to be removed for diagnostic purposes.

How Is Hysteroscopic Polypectomy Performed? This procedure is a type of operative hysteroscopy and generally involves the following steps:

  1. Anesthesia: Depending on the duration of the procedure and the patient’s condition, light general anesthesia, sedation, or regional anesthesia (spinal/epidural) is generally preferred. For very small polyps, it can sometimes also be performed under local anesthesia via office hysteroscopy.
  2. Preparation: The procedure is generally performed within the week after menstrual bleeding ends. If anesthesia will be given, the patient fasts for a certain period beforehand.
  3. Positioning and Sterilization: The patient is positioned as for a gynecological examination, and the vagina and cervix are sterilized.
  4. Insertion of the Hysteroscope: A thin hysteroscope (an operative type through which instruments can pass) is passed through the cervix and placed inside the uterus. The uterine cavity is distended with fluid.
  5. Visualizing and Removing the Polyp: The polyp(s) are clearly visualized with the camera. Using special instruments advanced through the working channel of the hysteroscope (scissors, grasping forceps, an electrosurgical resectoscope loop, or a special tissue morcellator), the polyp is carefully cut or detached at its base and removed.
  6. Final Check and Removal of Instruments: After the polyp is removed, its base is checked and, if necessary, lightly cauterized. The uterine cavity is inspected once more, the instruments are withdrawn, and the procedure is concluded.
  7. Pathology: The removed polyp or polyps are always sent for pathological examination to determine whether they are benign or malignant.

Procedure Duration: It generally takes between 15 and 30 minutes, depending on the size and number of polyps.

Advantages of Hysteroscopic Polypectomy (Closed Polyp Surgery)

This method has many advantages over traditional curettage for polyp removal:

  • Procedure Under Direct Visualization: The polyp and its base are removed under direct view, reducing the risk of residual tissue.
  • Complete and Effective Treatment: Removing the polyp together with its base increases treatment success.
  • Minimally Invasive: No abdominal incision is made.
  • Very Little Pain: Post-procedure pain is generally minimal.
  • Fast Recovery: Patients can generally return to their normal lives the same day or the next day.
  • Low Complication Rate: Risks are very low when performed by experienced hands.
  • Preservation of Fertility: Removing only the polyp without damaging the uterine tissue preserves fertility and may even improve it.

What Are the Risks of Closed Polyp Surgery (Hysteroscopy)?

Although hysteroscopic polypectomy is a very safe procedure, the following risks may very rarely occur:

  • Uterine perforation
  • Infection
  • Bleeding
  • Cervical injury
  • Fluid overload (in prolonged procedures)
  • Anesthesia-related risks

These risks are extremely low in procedures performed by an experienced surgeon under appropriate conditions.

Recovery After Closed Polyp Surgery and Points to Consider

Recovery after hysteroscopic polypectomy is generally very fast and comfortable:

  • Discharge: Most patients can go home a few hours after the procedure or the same day.
  • Pain: Mild cramp-like pain may occur, which is easily relieved with simple painkillers.
  • Bleeding/Discharge: Mild vaginal spotting or watery, pinkish discharge lasting a few days is considered normal. If heavy bleeding occurs, you should consult your doctor.
  • Activity: You can generally return to normal activities the next day. It is recommended to avoid strenuous activities for a few days.
  • Sexual Intercourse and Other Restrictions: For the period recommended by your doctor (generally 1-2 weeks), you should avoid sexual intercourse, tampon use, and vaginal douching.
  • Pathology Result: It is important to discuss the pathology result with your doctor after the surgery.
  • Recurrence: There is a chance (even if low) that polyps may recur over time, especially if an underlying hormonal cause is present. Regular gynecological check-ups are therefore recommended.

Closed Polyp Surgery (Hysteroscopy) in Ankara: A Safe Solution with Prof. Dr. Nuray Bozkurt

Prof. Dr. Nuray Bozkurt offers a modern and reliable service in Ankara for the diagnosis and treatment of intrauterine polyps:

  • Expert Diagnosis: She accurately diagnoses polyps using advanced ultrasonography (particularly SIS) and, when needed, diagnostic hysteroscopy.
  • Hysteroscopic Surgical Experience: She is experienced in operative hysteroscopy and aims to completely remove polyps together with their base using a minimally invasive method, without damaging the uterine tissue.
  • Safe Environment: She performs procedures in modern, sterile, and safe operating room or clinic conditions in Ankara.
  • Patient Comfort: She prioritizes patient comfort and pain control during and after the procedure.
  • Comprehensive Approach: In addition to removing the polyp, she evaluates any underlying causes and offers recommendations to prevent recurrence. In cases of infertility or abnormal bleeding, she provides a holistic treatment plan.
  • Open Communication: She informs her patients in detail about the process before and after the procedure and answers all their questions. She shares pathology results and creates a follow-up plan. Accessibility is important (0538 983 18 78) (0312 284 00 12).

If you have been diagnosed with an intrauterine polyp, if you have complaints such as abnormal bleeding or infertility, and if you are considering your treatment options, closed surgery (hysteroscopic polypectomy) may be the most suitable solution for you. You can meet with Prof. Dr. Nuray Bozkurt in Ankara to evaluate your condition, get detailed information about the hysteroscopy procedure, and create your treatment plan. For safe and comfortable treatment, please call 0538 983 18 78 to make an appointment.

What You’re Curious About

These are usually benign fleshy growths arising from the uterine lining. The risk of malignant transformation is very low (less than 1-5%), but this risk is somewhat higher in polyps that cause bleeding especially after menopause, which is why every removed polyp must be examined.

Their most common symptom is abnormal vaginal bleeding (intermenstrual bleeding, heavy menstrual bleeding, postmenopausal bleeding). They can also cause infertility or, rarely, miscarriages. In most cases, however, they cause no symptoms at all.

Although ultrasonography (especially fluid ultrasound – SIS) and a uterine X-ray (HSG) can be helpful for diagnosis, the gold-standard method is hysteroscopy, which allows the uterine cavity to be seen directly with a camera. Hysteroscopy provides both a definitive diagnosis and, at the same time, treatment (removal of the polyp).

No. Small polyps that cause no symptoms can be monitored. However, it is generally recommended to remove polyps that are symptomatic (bleeding, infertility), large (>1.5-2 cm), or detected after menopause.

A camera is inserted into the uterus, and the polyp is cut at its base and removed using special instruments. Since it is generally performed under light anesthesia, no pain is felt during the procedure. Mild cramping may occur afterward.

The procedure generally takes 15-30 minutes. Most patients are discharged a few hours after the procedure or the same day.

Hysteroscopy is a very safe procedure. Very rarely, risks such as uterine perforation, infection, or bleeding may occur. The complication rate is very low in experienced hands.

Recovery is very fast. You can generally return to normal activities the next day. Mild spotting may occur for a few days. It is recommended to avoid sexual intercourse for the period advised by your doctor (generally 1-2 weeks).

Yes, there is a chance (even if low) that polyps may recur. Recurrence can be seen especially if there is an underlying hormonal predisposition. Regular gynecological check-ups are therefore important.

You can make an appointment for polyp removal with hysteroscopy and evaluation of other intrauterine issues by calling Prof. Dr. Nuray Bozkurt’s clinic in Ankara at 0538 983 18 78.

You can contact us for information about the diagnosis and treatment process.

Contact

What Is Closed Polyp Surgery (Hysteroscopic Polypectomy)?

Endometrial polyps are mole-like structures extending into the uterine cavity, forming as a result of excessive growth of the endometrial tissue lining the inner layer of the uterus. Polyps are generally benign formations; however, by disrupting the uterine lining, they can lead to irregular bleeding, spotting between periods, or infertility by preventing the embryo from implanting in the uterus.

Closed polyp surgery, that is, hysteroscopic polypectomy, is a modern treatment method performed without making any surgical incision in the abdominal area. In Ankara, Prof. Dr. Nuray Bozkurt uses the hysteroscopy method, considered the gold standard, for the definitive diagnosis and same-session removal of polyps. With this procedure, polyps are removed from their site with millimetric precision, under direct visualization with a high-resolution camera.

Polyp Symptoms: In Which Cases Is Surgery Needed?

Intrauterine polyps may not always cause symptoms and can sometimes be detected incidentally during an ultrasound examination. However, as polyps grow larger or exert more pressure on the uterine lining, they lead to the following complaints:

Irregular Menstrual Bleeding: Menstrual periods lasting longer than normal or heavy bleeding occurring at unexpected times.
Intermenstrual Bleeding: Spotting or light bleeding seen between two menstrual periods.
Infertility: By occupying space within the uterus, a polyp can physically hinder embryo implantation or disrupt the chemistry of the uterine environment.
Recurrent Pregnancy Loss: Polyps that are particularly close to the cervix or very large can put the continuation of a pregnancy at risk.

At our clinic in Ankara, patients suspected of having a polyp are generally diagnosed with an ultrasound examination performed at the end of menstruation. If the polyp is causing complaints, if infertility is suspected, or if there is a risk of cellular change in the polyp (especially in the postmenopausal period), surgical removal is recommended.

How Is Closed Polyp Surgery (Hysteroscopy) Performed?

Closed polyp surgery is performed using the hysteroscopy method, a completely incision-free procedure. The greatest advantage of this method is that it focuses solely on the area where the polyp is located, without any intervention on the outer surface of the uterus.

Surgical Process The procedure is generally performed under light anesthesia (sedation), so the patient feels no pain at all. The cervix is passed through the vaginal route, and the uterus is entered with a thin device with a camera at its tip. The uterine cavity is gently distended with fluid to determine the exact location of the polyp. Using micro-surgical instruments, the polyp is carefully removed together with its base.

Polyp surgery performed with the hysteroscopic method generally takes between 15 and 30 minutes. Since there is no surgical incision or stitches, no scar remains after the procedure.

Post-Surgical Recovery and Return to Social Life

Since closed polyp surgery does not involve a surgical incision, the recovery process is very fast and comfortable. For our patients who undergo this procedure at our clinic in Ankara, the process generally proceeds as follows:

Hospital Stay and the First Hours After hysteroscopic polyp surgery, patients can be discharged approximately 2-4 hours after coming out of the anesthesia. No overnight hospital stay is needed after the procedure. It is normal to feel mild cramps similar to menstrual pain for the first few hours, and this is easily controlled with simple painkillers.

Daily Life and Hygiene Since there are no visible external stitches or scars, patients can return to their normal daily activities and work life the day after surgery. There is no problem taking a standing shower 24 hours after the procedure. Mild, spotting-type vaginal bleeding may be seen for the first few days; this is a normal part of tissue healing.

Sexual Life Restriction To prevent the risk of infection and allow the uterine lining to heal properly, it is recommended to avoid sexual intercourse for the first 1-2 weeks following surgery.

The Relationship Between Polyps and Infertility/Pregnancy

Intrauterine polyps are one of the important structural obstacles that reduce the chance of pregnancy in women who want to have children. The presence of a polyp can negatively affect pregnancy in two different ways:

  1. Implantation Site Obstruction: The polyp forms a physical barrier by occupying the area of the uterine wall where the embryo needs to attach.

  2. Embryo Acceptance: By causing micro-inflammation in the uterine environment, it can make healthy embryo implantation and growth more difficult.

When a polyp is detected in our patients undergoing infertility treatment or planning IVF in Ankara, removing the polyp with hysteroscopy before transfer significantly increases pregnancy success rates. After the polyp is removed, pregnancy can generally be safely planned after waiting 1-2 menstrual cycles.

Frequently Asked Questions

The most frequently asked questions about intrauterine polyps and the closed surgery process are as follows:

Do uterine polyps turn into cancer? The vast majority of polyps are benign. However, they can carry a very low cancer risk, particularly in postmenopausal women or when the polyp’s cellular structure shows irregularity. For this reason, every removed polyp must be sent for pathological examination.

Can polyps recur after surgery? There is a possibility of polyps recurring. If the hormonal background or structural predisposition that caused the polyp continues, a new polyp may develop in a different area of the uterine lining. Regular gynecological check-ups are important for early detection of this.

Is polyp surgery painful? Since the hysteroscopic method is an incision-free procedure, no pain is felt during the procedure. Mild cramps that may occur within 24 hours after the procedure are easily relieved with standard painkillers.

When can I become pregnant after polyp surgery? After the polyp is removed, it is generally recommended to wait for 1 or 2 menstrual cycles so that the uterine lining can repair itself. After that, there is no longer any obstacle to pregnancy.

When can sexual intercourse resume after surgery? To prevent the risk of infection and speed up healing, it is advised to avoid sexual intercourse for the first 10-14 days following surgery.

Closed Polyp Treatment in Ankara and Appointments

Intrauterine polyps are formations that, when addressed in a timely manner, quickly improve the patient’s quality of life and resolve problems such as infertility. Prof. Dr. Nuray Bozkurt provides an expert approach to the diagnosis and hysteroscopic treatment of polyps at her clinic in Ankara.

If you have complaints of irregular bleeding or are experiencing obstacles to having children, you can contact us for polyp diagnosis and modern treatment methods.

Detailed Information and Appointments: 0312 284 00 12