Introduction
Uterine polyps are usually benign finger-like growths of the endometrial lining protruding into the uterine cavity. They differ from fibroids, which arise from the muscle wall. Polyps may be single or multiple and vary from millimeters to several centimeters.
Many polyps cause no symptoms; others cause irregular bleeding, heavy periods, spotting after intercourse, or infertility. Postmenopausal bleeding with a polyp always needs evaluation to exclude endometrial cancer.
Diagnosis is by ultrasound, sonohysterography, or hysteroscopy—the latter allows removal and tissue diagnosis in one step. Most polyps are benign endometrial or endocervical type; hyperplasia or cancer is uncommon but must be ruled out.
This page is general health education. It is not personal gynecologic or surgical advice. Seek prompt care for postmenopausal bleeding or very heavy periods.
Overview
Polyps form when localized overgrowth of endometrium and glands projects into the cavity, often on a stalk. Hormonal sensitivity especially to estrogen may promote growth.
Prevalence increases with age until menopause; some regress spontaneously. Hysteroscopic polypectomy is standard when symptomatic or when fertility is desired.
Differentiate from fibroids (muscle origin), endometrial hyperplasia, and cancer by imaging and histology.
- Benign endometrial lining growths in the cavity
- Not the same as fibroids or cervical polyps alone
- Symptoms: irregular bleeding, spotting, infertility
- Postmenopausal bleeding requires cancer exclusion
- Diagnosis: ultrasound, sonohysterography, hysteroscopy
- Treatment: hysteroscopic removal when indicated
- Most benign; histology confirms no hyperplasia or cancer
What happens in the body
Focal endometrial hyperplasia with fibrotic stroma forms a polyp attached by a stalk or broad base. Estrogen stimulation and local growth factors may drive formation; chronic inflammation or tamoxifen exposure are associated.
Polyps can interfere with embryo implantation and cause irregular shedding of overlying tissue, leading to bleeding. Malignant transformation is rare but more concerning in postmenopausal women or with atypical histology.
- Localized endometrial overgrowth into the cavity
- Estrogen-sensitive tissue may enlarge with hormonal cycles
- Mechanical interference with implantation in fertility cases
- Surface ulceration causes spotting and irregular bleeding
- Histology needed to exclude hyperplasia or malignancy
Signs and symptoms
Many are silent; when symptomatic:
- Intermenstrual or irregular bleeding
- Heavier or prolonged periods
- Spotting or bleeding after sexual intercourse
- Postmenopausal vaginal bleeding
- Pink or brown discharge
- Infertility or difficulty conceiving
- Recurrent early pregnancy loss in some cases
- Pelvic cramping occasionally
- Asymptomatic polyp found on imaging for other reasons
- Anemia from chronic blood loss over time
- Bleeding after starting tamoxifen
- No pain in most cases unless large polyp causes cramping
Causes and risk factors
Exact cause unclear; associated factors include:
- Estrogen exposure and hormonal imbalance
- Age-related endometrial changes before menopause
- Tamoxifen use in breast cancer treatment
- Obesity increasing circulating estrogen
- Hypertension and metabolic syndrome associations
- Chronic endometrial inflammation
- Rare genetic syndromes (Lynch) when hyperplasia coexists
- Nulliparity and late menopause
- Prior endometrial hyperplasia
- Idiopathic in many patients
Diagnosis and evaluation
Imaging plus direct visualization and biopsy:
- Bleeding history, medications (tamoxifen), fertility goals
- Pelvic examination—cervical polyps may be visible
- Transvaginal ultrasound showing focal endometrial thickening
- Saline infusion sonohysterography defining polyp shape
- Hysteroscopy—gold standard for view and removal
- Endometrial biopsy or polyp histology after removal
- Exclude fibroids, hyperplasia, and endometrial carcinoma
Treatment and management
Asymptomatic small polyps may be observed; symptomatic or high-risk cases need removal:
- Watchful waiting for tiny asymptomatic premenopausal polyps in selected cases
- Hysteroscopic polypectomy for bleeding, infertility, or postmenopausal polyps
- Histologic examination of all removed tissue
- Hormonal management (progestins, IUD) for recurrent bleeding when appropriate
- Treat underlying obesity or metabolic risk factors
- Repeat hysteroscopy if symptoms recur
- Further staging if malignancy found on pathology
- Fertility-focused timing of polypectomy before IVF when indicated
Prevention, self-care, and lifestyle
Not every condition is fully preventable, but the steps below may lower risk or recurrence:
- No proven way to prevent all polyps
- Maintain healthy weight to limit excess estrogen
- Report abnormal bleeding promptly especially after menopause
- Regular follow-up on tamoxifen per oncology guidance
- Manage hypertension and metabolic health
Possible complications
Delay, missed care, or unsafe self-medication can raise the chance of complications in some cases:
- Anemia from chronic bleeding
- Infertility or miscarriage when cavity distorted
- Rare progression to atypical hyperplasia or endometrial cancer
- Polyp recurrence after removal
- Procedure risks: bleeding, infection, uterine perforation (uncommon)
- Missed malignancy if polyp not fully evaluated histologically
When to see a doctor or seek emergency care
Seek prompt medical advice or emergency care if any of the following apply—it is safer not to wait and see:
- Any bleeding after menopause
- Persistent intermenstrual bleeding
- Heavy periods soaking pads hourly
- Bleeding after intercourse repeatedly
- Difficulty conceiving or recurrent miscarriage
- Bleeding on tamoxifen—notify oncology and gynecology teams
Living with the condition
After polypectomy, expect light bleeding briefly; report fever or heavy bleeding.
If trying to conceive, follow timing advice for intercourse or IVF after healing.
Keep gynecologic follow-up if polyps recur or new bleeding appears.
Frequently asked questions
Are uterine polyps cancer?
Most are benign. Postmenopausal bleeding and atypical histology raise cancer risk and need full evaluation.
Do all polyps need surgery?
No—small asymptomatic premenopausal polyps may be watched; symptomatic, large, or postmenopausal polyps are usually removed.
Can polyps cause infertility?
Yes—they can block implantation; hysteroscopic removal often improves fertility outcomes.
Can polyps come back?
Yes, recurrence is possible—report new bleeding after polypectomy.
How is removal done?
Most are taken out hysteroscopically as outpatient surgery with quick recovery.
What is the difference from fibroids?
Polyps grow from the lining; fibroids from the muscle wall—diagnosis and treatment differ.
Important caution
This article is general health education in English. It is not personal medical advice.
Diagnosis and treatment should be guided by a qualified clinician who knows your full history.
Seek urgent care for severe, sudden, or rapidly worsening symptoms.