Both uterine fibroids and polyps are common, non-cancerous growths that develop in the uterus. While neither is usually life-threatening, they can cause unpleasant symptoms and complications. Determining which is “worse” depends on factors like size, location, and symptoms.
What are Fibroids?
Uterine fibroids are benign tumors that grow on the muscle of the uterus. They are extremely common, affecting up to 80% of women by age 50. However, not all fibroids cause problems or need treatment.
There are several types of fibroids:
- Intramural fibroids – grow within the muscle wall of the uterus
- Subserosal fibroids – grow on the outer surface of the uterus
- Pedunculated fibroids – grow on small stalks inside or outside the uterus
- Submucosal fibroids – grow just under the uterine lining
Fibroids range greatly in size, from microscopic to several inches across. They may be single or multiple. The exact causes are unclear, but estrogen and progesterone appear to promote growth.
Fibroid Symptoms
Most small fibroids do not cause any symptoms. However, some women with larger fibroids may experience:
- Heavy, prolonged menstrual bleeding
- Pelvic pain and pressure
- Frequent urination
- Lower back pain
- Painful intercourse
- Reproductive problems, like infertility and miscarriage
Symptoms depend on the number, size, location of fibroids. Submucosal fibroids that bulge into the uterine cavity are most likely to cause heavy, prolonged periods and pelvic pain. Some fibroids may enlarge the uterus enough to make it feel like pregnancy.
What are Polyps?
Uterine polyps are overgrowths of tissue attached to the inner wall of the uterus by a stalk or pedicle. They are extremely common, affecting up to 25% of women.
Polyps are usually small, measuring between a few millimeters to a few centimeters. They are rarely larger than 2–3 centimeters. Polyps may be single or multiple.
The specific causes of polyps are not well understood but are related to hormone imbalances. Like fibroids, they seem to be fueled by estrogen. Other risk factors include obesity, hypertension and early onset of periods.
Polyps Symptoms
Small polyps often produce no symptoms. Larger ones can cause:
- Abnormal uterine bleeding, like heavy periods or bleeding between periods
- Bloody vaginal discharge
- Pelvic pain
- Pain with bowel movements or urination
- Infertility or miscarriage
Submucosal polyps that protrude into the uterine cavity are more likely to cause abnormal bleeding and reproductive issues.
Fibroids vs. Polyps: Key Differences
Here is a comparison of some key differences between uterine fibroids and polyps:
| Characteristic | Fibroids | Polyps |
|---|---|---|
| Composition | Made of muscle | Overgrowth of endometrial tissue |
| Location | Grow on uterus muscle wall | Attached to uterine lining by stalk |
| Shape/Structure | Round, smooth, solid tumors | Bulbous, mushroom-like lesions |
| Size | Can grow very large | Usually small, under 2-3 cm |
| Number | Often multiple | Often single |
| Caused by hormones | Estrogen and progesterone promote growth | Related to estrogen imbalance |
| Cancer risk | Extremely low | Slightly higher than fibroids |
In summary, fibroids grow larger, are more likely to be multiple, and develop from uterine muscle tissue. Polyps tend to be smaller, singular, and composed of endometrial cells.
Diagnosis
Both uterine fibroids and polyps are often found incidentally during a routine pelvic exam. Specific diagnostic tests may include:
- Pelvic ultrasound – Uses sound waves to examine pelvic organs. Can identify size and location of fibroids and polyps.
- Saline infusion sonohysterography – Saline is injected into the uterus during vaginal ultrasound to enhance visualization of abnormalities.
- Hysteroscopy – A thin tube with a camera (hysteroscope) is inserted through the cervix allowing direct examination of the uterine cavity.
- Hysterectomy biopsy – If fibroids or polyps are discovered during hysterectomy, biopsy examination will determine if they are cancerous.
For most women, an ultrasound paired with a hysteroscopic biopsy usually provides a definitive diagnosis. Tissue removal allows pathologic testing to confirm benign growths.
Complications
Some potential complications of untreated uterine fibroids and polyps include:
Fibroids Complications
- Excessive menstrual bleeding leading to anemia
- Reproductive problems, like infertility, miscarriage risk
- Pregnancy complications if rapidly growing
- Pelvic pain
- Bladder control issues if large growths press on bladder
- Rarely, fibroid degeneration
Polyps Complications
- Abnormal uterine bleeding, anemia
- Infertility risk
- Pregnancy loss
- Pelvic pain
- Polyp overgrowth if untreated for years
- Slightly increased uterine cancer risk
Problematic fibroids or polyps may necessitate treatment to improve symptoms and prevent long-term complications like anemia. Both can negatively impact fertility if they bulge into the uterine cavity.
Treatment Options
Treatment depends on several factors – number, size, location of growths, severity of symptoms, plans for pregnancy, and woman’s age. Options may include:
Fibroid Treatment Options
- Watchful waiting – If fibroids are small and no symptoms
- Medications – Limiting hormones may shrink fibroids
- MRI-guided ultrasound surgery – Shrinks fibroids with high-intensity ultrasound waves
- Uterine artery embolization – Blocks blood supply to fibroids to make them shrink
- Myomectomy – Surgical removal of fibroids leaving the uterus intact
- Hysterectomy – Surgical removal of the uterus, a last resort
Polyps Treatment Options
- Watchful waiting – If polyp is small and no symptoms
- Medications – Limiting estrogen exposure may shrink polyps
- Polypectomy – Removal of polyp via hysteroscopy
- Hysteroscopic resection – Shaving polyp’s base via hysteroscopy
- Hysterectomy – Uterus removal, for large or numerous polyps
Usually polyp removal through hysteroscopy is the first-line treatment. Problematic fibroids may require more invasive surgical procedures or uterus removal.
Recovery and Outlook
Recovery depends greatly on what type of treatment is performed:
- Medications – Fibroids/polyps may shrink over 3-6 months but regrow when medication stopped
- Office polypectomy – Mild cramping for few days; normal activity can resume quickly
- Uterine artery embolization – Back to normal in 1 week typically
- Myomectomy – 4-6 weeks rest; avoid heavy activity
- Hysterectomy – 6 week recovery; no heavy lifting
Procedural interventions often relieve symptoms more permanently than medications alone. However, fibroids or polyps can still recur in the future, especially if estrogen levels rise again after menopause.
Which is Worse – Fibroids or Polyps?
It is difficult to claim fibroids or polyps are clearly “worse” than the other. Which condition has more severe impacts depends on individual factors:
- Size – Larger fibroids generally cause more problems than small polyps
- Location – Submucosal growths protruding into the uterine cavity tend to be more symptomatic
- Number – Multiple growths often increase symptoms
- Symptoms – The severity of bleeding, pain, reproductive issues guides treatment
- Growth rate – Rapidly enlarging fibroids may require urgent treatment
- Cancer risk – Polyps are slightly more concerning for possible malignancy
To summarize, rapidly growing, large, or multiple fibroids are often considered worse than solitary small polyps. However, even one small submucous fibroid or polyp can cause significant bleeding or infertility if located in a problematic spot.
Conclusion
Uterine fibroids and endometrial polyps have some similarities, but also differ in their structures, origins, sizes, and cancer risks. Determining which is worse depends greatly on the specifics of each woman’s presentation.
In general, larger or rapidly growing fibroids may require more involved treatment like surgery. Small, symptom-free polyps may only need monitoring. However, even one tiny lesion in a bad location can have greater impacts on fertility or bleeding than multiple large ones away from the uterine cavity.
The best approach is to have abnormal uterine bleeding or pelvic pain evaluated with imaging tests. From there, treatment decisions can be made based on each patient’s examination findings, symptom severity, reproductive plans, and other considerations. With appropriate management guided by a knowledgeable physician, both fibroids and polyps can often be treated effectively.