Fibroids and polyps are both common gynecological conditions encountered in clinical practice. Even though there are different types of fibroids and polyps, endometrial polyps and uterine fibroids are the two entities that usually cause confusion. Both conditions have somewhat similar presentations and ultrasound scan findings also can be equivocal. Despite these clinical pitfalls, there are many differences between fibroids and polyps, which is discussed here in detail.
Fibroids are abnormal growths arising from fibrous connective tissue of the uterus. They can occur singly and in clusters. They may be big and small. According to the site, there are four types of fibroids. They are sub-endometrial, intramural, sub-serosal and pedunculated fibroids. Sub-endometrial fibroids are located under the endometrium in the myometrium. Intramural fibroids are found embedded inside the myometrium. Sub-serosal fibroids protrude outwards from inside the myometrium. Pedunculated fibroids lie connected to the uterus by a stalk.
Fibroids may present in many ways. Most commonly fibroids cause excessive menstrual bleeding. Intramural fibroids interfere with uterine muscle contraction and retards hemostasis after menstruation. Sub-endometrial fibroids increase the surface area of the endometrium and increase the amount of tissue sensitive to hormonal changes. Sometimes fibroids present as slow growing abdominal masses. Sub-serosal and pedunculated fibroids can impinge on pelvic and abdominal structures and cause pressure symptoms. Fibroids may cause sub-fertility by interfering with implantation of the fertilized ovum.
Fibroids can undergo red degeneration, hyaline degeneration, fat degeneration, calcification and migration. Malignant transformation is extremely rare. If asymptomatic, fibroids do not need removal because they regress automatically after menopause. If symptomatic, myomectomy and hysterectomy are curative.
Polyps can arise from any site. In gynecological practice, cervical polyps and endometrial polyps are encountered very frequently. Cervical polyps present as irregular vaginal bleeding, post coital bleeding and incidentally at well-women-clinics. Cervical polyps need to be excised and examined under the microscope, to determine if they are benign or malignant.
Endometrial polyps usually present as irregular menstrual bleeding and excessive menstrual bleeding. Ultrasound scan of pelvis shows increased endometrial thickness. This requires biopsy and histological investigation. Some endometrial polyps are benign, and only a small proportion recurs after excision. Some endometrial polyps are malignant and need hysterectomy.
What is the difference between Fibroids and Polyps?
• Fibroids are of connective tissue origin while polyps are of epithelial origin. (Read the Difference Between Epithelial and Connective Tissue)
• Fibroids can be very large while polyps usually are small.
• Fibroids can cause significant uterine enlargement while polyps do not.
• Fibroids are almost never malignant while a significant number of endometrial polyps are malignant.
• Fibroids do not need treatment if asymptomatic while polyps always require removal and histological analysis.
• Fibroids are estrogen sensitive while estrogen excess is a risk factor for endometrial polyps.
• Fibroids can undergo hyaline, red and fat degeneration while polyps do not. Fibroids regress after menopause while polyps disintegrate.
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