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Endometrial polyp
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<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>They often cause no symptoms.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a> Where they occur, symptoms include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual bleeding (<a href="/facts/Menorrhagia/cQUgAGNk">menorrhagia</a>), and vaginal bleeding after <a href="/facts/Menopause/b3Fz6NHb">menopause</a>.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a><a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> Bleeding from the blood vessels of the polyp contributes to an increase of blood loss during menstruation and blood "spotting" between menstrual periods, or after menopause.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> If the polyp protrudes through the cervix into the vagina, pain (<a href="/facts/Dysmenorrhea/WFNGwoY9">dysmenorrhea</a>) may result.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> </p> <h2 id="cause">Cause</h2> <p>No definitive cause of endometrial polyps is known, but they appear to be affected by hormone levels and grow in response to circulating <a href="/facts/Estrogen/dPEewnDV">estrogen</a>.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> Risk factors include <a href="/facts/Obesity/RBF9y5Vl">obesity</a>, <a href="/facts/High_blood_pressure/wlAvBfcf">high blood pressure</a> and a history of <a href="/facts/Cervical_polyp/3D5lxcQL">cervical polyps</a>.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> Taking <a href="/facts/Tamoxifen/oHU8n7ch">tamoxifen</a> or <a href="/facts/Hormone_replacement_therapy_(menopause)/d3KW80rn">hormone replacement therapy</a> can also increase the risk of uterine polyps.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a><a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> The use of an <a href="/facts/IUD_with_progestogen/UrRKseI7">intrauterine system</a> containing <a href="/facts/Levonorgestrel/BHJc8A96">levonorgestrel</a> in women taking tamoxifen may reduce the incidence of polyps.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> </p> <h2 id="diagnosis">Diagnosis</h2> <p>Endometrial polyps can be detected by <a href="/facts/Vagina/ca5jsTwF">vaginal</a> <a href="/facts/Gynecologic_ultrasonography/0HQbcqke">ultrasound</a> (sonohysterography), <a href="/facts/Hysteroscopy/Rnz51v2H">hysteroscopy</a> and <a href="/facts/Dilation_and_curettage/xqGeffEn">dilation and curettage</a>.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a> Detection by ultrasonography can be difficult, particularly when there is <a href="/facts/Endometrial_hyperplasia/NAnKxrYs">endometrial hyperplasia</a> (excessive thickening of the endometrium).<a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a> Larger polyps may be missed by curettage.<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> </p><p>Endometrial polyps can be solitary or occur with others.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> They are round or oval and measure between a few millimeters and several centimeters in diameter.<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a><a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> They are usually the same red/brown color of the surrounding endometrium although large ones can appear to be a darker red.<a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a> The polyps consist of dense, fibrous tissue (<a href="/facts/Stromal_cell/31AA691H">stroma</a>), blood vessels and glandlike spaces lined with endometrial <a href="/facts/Epithelium/ecKHcHC3">epithelium</a>.<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> If they are pedunculated, they are attached by a thin stalk (pedicle). If they are sessile, they are connected by a flat base to the uterine wall.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a> Pedunculated polyps are more common than sessile ones.<a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a> </p> <h2 id="treatment">Treatment</h2> <p>Polyps can be surgically removed using <a href="/facts/Curettage/qoxUcuuX">curettage</a> with or without hysteroscopy.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> When curettage is performed without hysteroscopy, polyps may be missed. To reduce this risk, the uterus can be first explored using grasping <a href="/facts/Forceps/JQK3rCev">forceps</a> at the beginning of the curettage procedure.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> Hysteroscopy involves visualising the endometrium (inner lining of the uterus) and polyp with a camera inserted through the <a href="/facts/Cervix/qw3gl8Pq">cervix</a>. Large polyps can be cut into sections before each section is removed.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a> The presence of <a href="/facts/Cancer/PVW6n1D0">cancerous</a> cells may suggest a <a href="/facts/Hysterectomy/WneLXgCu">hysterectomy</a> (surgical removal of the uterus).<a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> A hysterectomy is usually not considered when cancer is not present.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> In either procedure, <a href="/facts/General_anesthetic/YNM2tqty">general anesthetic</a> is typically supplied.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> </p><p>The effects of polyp removal on fertility has not been studied.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> </p> <h2 id="prognosis">Prognosis</h2> <p>Endometrial polyps are usually <a href="/facts/Benign_tumor/ssJPkY84">benign</a> although some may be <a href="/facts/Precancerous/cU1R35vW">precancerous</a> or <a href="/facts/Cancerous/PVW6n1D0">cancerous</a>.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> About 0.5% of endometrial polyps contain <a href="/facts/Adenocarcinoma/TU7W6WbJ">adenocarcinoma</a> cells.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> Polyps can increase the risk of <a href="/facts/Miscarriage/sFq0vdnU">miscarriage</a> in women undergoing <a href="/facts/IVF/kQNMtaBu">IVF</a> treatment.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> If they develop near the <a href="/facts/Fallopian_tube/oyRcvAxE">fallopian tubes</a>, they may lead to difficulty in becoming pregnant.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> Although treatments such as hysteroscopy usually cure the polyp concerned, recurrence of endometrial polyps is frequent.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a> Untreated, small polyps may regress on their own.<a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a> </p> <h2 id="epidemiology">Epidemiology</h2> <p>Endometrial polyps usually occur in women in their 40s and 50s.<a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> Endometrial polyps occur in up to 10% of women.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> It is estimated that they are present in 25% of women with abnormal vaginal bleeding.<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Cervical_polyp/3D5lxcQL">Cervical polyp</a></li> <li><a href="/facts/Uterine_fibroids/xqGmDE2J">Uterine fibroids</a></li></ul> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>WHO Classification of Tumours Editorial Board, ed. (2020). "6. Tumours of the uterine corpus: Endometrial polyp". Female genital tumours: WHO Classification of Tumours. Vol. 4 (5th ed.). Lyon (France): International Agency for Research on Cancer. p. 268. ISBN 978-92-832-4504-9. <a href="978-92-832-4504-9" target="_blank">978-92-832-4504-9</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Jane A. Bates (1997). Practical Gynaecological Ultrasound. Cambridge, UK: Cambridge University Press. ISBN 1-900151-51-0. <a href="1-900151-51-0" target="_blank">1-900151-51-0</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Sternberg, Stephen S.; Stacey E. Mills; Darryl Carter (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins. p. 2460. ISBN 0-7817-4051-7. <a href="0-7817-4051-7" target="_blank">0-7817-4051-7</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Jane A. Bates (1997). Practical Gynaecological Ultrasound. Cambridge, UK: Cambridge University Press. ISBN 1-900151-51-0. <a href="1-900151-51-0" target="_blank">1-900151-51-0</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Dysmenorrhea: Menstrual abnormalities at The Merck Manual of Diagnosis and Therapy Professional Edition <a href="http://www.merck.com/mmpe/sec18/ch244/ch244d.html" target="_blank">http://www.merck.com/mmpe/sec18/ch244/ch244d.html</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Jane A. Bates (1997). Practical Gynaecological Ultrasound. Cambridge, UK: Cambridge University Press. ISBN 1-900151-51-0. <a href="1-900151-51-0" target="_blank">1-900151-51-0</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Sternberg, Stephen S.; Stacey E. Mills; Darryl Carter (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins. p. 2460. ISBN 0-7817-4051-7. <a href="0-7817-4051-7" target="_blank">0-7817-4051-7</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>"Endometrial Polyp". GPnotebook. Retrieved 2007-10-20. <a href="http://www.gpnotebook.co.uk/simplepage.cfm?ID=1214971910" target="_blank">http://www.gpnotebook.co.uk/simplepage.cfm?ID=1214971910</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Dysmenorrhea: Menstrual abnormalities at The Merck Manual of Diagnosis and Therapy Professional Edition <a href="http://www.merck.com/mmpe/sec18/ch244/ch244d.html" target="_blank">http://www.merck.com/mmpe/sec18/ch244/ch244d.html</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Edmonds, D. Keith; Sir John Dewhurst (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing. p. 637. ISBN 1-4051-5667-8. <a href="1-4051-5667-8" target="_blank">1-4051-5667-8</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Chan SS, Tam WH, Yeo W, et al. (2007). "A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women". BJOG. 114 (12): 1510–5. doi:10.1111/j.1471-0528.2007.01545.x. PMID 17995495. S2CID 21145823. <a href="https://doi.org/10.1111%2Fj.1471-0528.2007.01545.x" target="_blank">https://doi.org/10.1111%2Fj.1471-0528.2007.01545.x</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Jane A. Bates (1997). Practical Gynaecological Ultrasound. Cambridge, UK: Cambridge University Press. ISBN 1-900151-51-0. <a href="1-900151-51-0" target="_blank">1-900151-51-0</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>Macnair, Trisha. "Ask the doctor – Uterine polyps". BBC Health. Retrieved 2007-10-21. <a href="https://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml" target="_blank">https://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Bajo Arenas, José M.; Asim Kurjak (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis. p. 502. ISBN 1-84214-331-X. <a href="1-84214-331-X" target="_blank">1-84214-331-X</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Bajo Arenas, José M.; Asim Kurjak (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis. p. 502. ISBN 1-84214-331-X. <a href="1-84214-331-X" target="_blank">1-84214-331-X</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Bajo Arenas, José M.; Asim Kurjak (2005). Donald School Textbook Of Transvaginal Sonography. Taylor & Francis. p. 502. ISBN 1-84214-331-X. <a href="1-84214-331-X" target="_blank">1-84214-331-X</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>Sternberg, Stephen S.; Stacey E. Mills; Darryl Carter (2004). Sternberg's Diagnostic Surgical Pathology. Lippincott Williams & Wilkins. p. 2460. ISBN 0-7817-4051-7. <a href="0-7817-4051-7" target="_blank">0-7817-4051-7</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>"Uterine bleeding – Signs and Symptoms". UCSF Medical Center. 2007-05-08. Archived from the original on 2008-04-11. Retrieved 2007-10-20. <a href="https://web.archive.org/web/20080411022146/http://www.ucsfhealth.org/adult/medical_services/womens_health/gynecology/conditions/ubleed/signs.html" target="_blank">https://web.archive.org/web/20080411022146/http://www.ucsfhealth.org/adult/medical_services/womens_health/gynecology/conditions/ubleed/signs.html</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Macnair, Trisha. "Ask the doctor – Uterine polyps". BBC Health. Retrieved 2007-10-21. <a href="https://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml" target="_blank">https://www.bbc.co.uk/health/ask_the_doctor/uterinepolyp.shtml</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Jayaprakasan, K; Polanski, L; Sahu, B; Thornton, JG; Raine-Fenning, N (Aug 30, 2014). "Surgical intervention versus expectant management for endometrial polyps in subfertile women" (PDF). The Cochrane Database of Systematic Reviews. 8 (8): CD009592. doi:10.1002/14651858.CD009592.pub2. PMC 6544777. PMID 25172985. Archived from the original (PDF) on November 4, 2018. Retrieved November 4, 2018. <a href="https://web.archive.org/web/20181104211152/http://eprints.nottingham.ac.uk/31823/1/Jayaprakasan_et_al-2014-The_Cochrane_library.pdf" target="_blank">https://web.archive.org/web/20181104211152/http://eprints.nottingham.ac.uk/31823/1/Jayaprakasan_et_al-2014-The_Cochrane_library.pdf</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>Rubin, Raphael; David S Strayer (2007). Rubin's Pathology: Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 806. ISBN 978-0-7817-9516-6.{{cite book}}: CS1 maint: location missing publisher (link) <a href="978-0-7817-9516-6" target="_blank">978-0-7817-9516-6</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>DeCherney, Alan H.; Lauren Nathan (2003). Current Obstetric & Gynecologic Diagnosis & Treatment. McGraw-Hill Professional. p. 703. ISBN 0-8385-1401-4. <a href="0-8385-1401-4" target="_blank">0-8385-1401-4</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>Kaunitz, Andrew M. (2002-08-26). "Asymptomatic Endometrial Polyps: What Is the Likelihood of Cancer?". Medscape Ob/Gyn & Women's Health. Retrieved 2008-04-20. <a href="http://www.medscape.com/viewarticle/440353" target="_blank">http://www.medscape.com/viewarticle/440353</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>"Uterine polyps". MayoClinic.com. 2006-04-27. <a href="http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1" target="_blank">http://www.mayoclinic.com/health/uterine-polyps/DS00699/DSECTION=1</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Jane A. Bates (1997). Practical Gynaecological Ultrasound. Cambridge, UK: Cambridge University Press. ISBN 1-900151-51-0. <a href="1-900151-51-0" target="_blank">1-900151-51-0</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>Edmonds, D. Keith; Sir John Dewhurst (2006). Dewhurst's Textbook of Obstetrics and Gynaecology. Blackwell Publishing. p. 637. ISBN 1-4051-5667-8. <a href="1-4051-5667-8" target="_blank">1-4051-5667-8</a> <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> </ol>