What is a uterine polyp?
A uterine polyp is an overgrowth of the tissue lining the uterine cavity or the cervical canal that projects inwards from the surface. Polyps range from a few millimetres to several centimetres, may be single or multiple, and may hang on a thin stalk (pedunculated) or sit on a broad base (sessile). The great majority are benign.
Endometrial polyps
These arise from the endometrium, the inner lining of the uterus, and are sensitive to oestrogen. They are therefore more common when oestrogen stimulation continues for a long time without the balancing effect of progesterone. Reported prevalence ranges from about 8% to 35%, and many are found incidentally on an ultrasound done for another reason.
Cervical (endocervical) polyps
These grow from the lining of the cervical canal and are usually seen during a pelvic examination as a soft, reddish growth protruding from the cervix. They are common in women in their 40s and 50s and in women who have given birth. They are usually benign but may cause bleeding after intercourse. Because some women with a cervical polyp also have an endometrial polyp, the inside of the uterus is also assessed when there is abnormal bleeding.
Who is more likely to have polyps?
- Age: polyps become more common with age, particularly after 40 and around menopause.
- Overweight and obesity: oestrogen produced in fat tissue stimulates the endometrium.
- Tamoxifen: this breast cancer drug has an oestrogen-like effect on the endometrium and clearly increases polyp risk.
- High blood pressure: associated with polyps in some studies.
- Hormone use: some menopausal hormone therapies may be associated with polyps; adding progestogen to oestrogen protects the lining in women with a uterus.
- Infertility: polyps are found more often in women having difficulty conceiving.
What are the symptoms?
Many polyps cause no symptoms and are found at a routine check. When symptoms occur, the main one is abnormal uterine bleeding:
- Spotting or bleeding between periods
- Heavy or prolonged periods
- Irregular periods
- Bleeding after intercourse (especially with cervical polyps)
- Bleeding or spotting after menopause
- Difficulty conceiving
Any bleeding after menopause, however light, should be assessed. The cause is usually benign, such as a polyp or thinning of the lining (atrophy), but precancerous changes and cancer of the endometrium must be excluded.
How are polyps diagnosed?
Transvaginal ultrasound
This is the first-line test. Before menopause, scanning shortly after a period, when the lining is thin, shows polyps more clearly. Colour Doppler showing a feeding vessel supports the diagnosis.
Saline infusion sonography (sonohysterography)
A small amount of sterile saline is introduced into the uterine cavity through a thin catheter during ultrasound. The fluid separates the walls of the cavity so the size, number and position of polyps are seen more clearly. It is more sensitive than standard ultrasound.
Hysteroscopy
A thin camera is used to look directly inside the uterus; this is regarded as the reference method for diagnosis. Diagnostic hysteroscopy can often be done in an outpatient setting without general anaesthesia, and a polyp can often be removed in the same session. Blind curettage is not recommended because parts of the polyp may be left behind.
Cervical polyps are usually seen directly with a speculum. Every polyp removed is sent for pathological examination.
Can polyps become cancerous?
Most uterine polyps are benign. The chance of finding precancerous change (atypical hyperplasia) or cancer within a polyp is low, around 1% in premenopausal women. It rises with age and is higher after menopause, particularly in women with bleeding. Tamoxifen use and obesity also increase the risk. For this reason, polyps causing postmenopausal bleeding should be removed and examined. Malignant change in cervical polyps is very rare.
Do polyps affect fertility?
Polyps are found more often in women with difficulty conceiving. By occupying space in the cavity, causing local inflammatory changes in the lining and disturbing the environment needed for implantation, they may reduce fertility, although some women with polyps conceive naturally.
In women who wish to conceive, hysteroscopic removal before insemination (IUI) or IVF is often considered. A randomised trial has shown higher pregnancy rates after polyp removal before IUI; evidence before IVF is more limited. The decision takes into account polyp size and position, age, previous treatment and the planned treatment. If a small polyp is noticed during an IVF cycle, freezing the embryos and transferring them after polyp removal is one option.
Treatment
Treatment depends on symptoms, menopausal status, polyp size and number, cancer risk factors and fertility wishes.
Monitoring
For premenopausal women without symptoms and with a small polyp (under about 10 mm), monitoring is a reasonable option; in studies up to about a quarter of such polyps regressed spontaneously. Follow-up ultrasound is planned, and treatment is reconsidered if bleeding, a wish to conceive or growth occurs.
Hysteroscopic polypectomy
When treatment is needed, the standard approach is removal under direct vision with hysteroscopy. Small instruments passed through a thin camera remove the polyp at its base without any abdominal incision. Small polyps can often be removed in the outpatient setting with local or no anaesthesia; larger or multiple polyps may be removed under brief anaesthesia in theatre. It is usually a day procedure.
Complications are uncommon and include infection, bleeding, perforation of the uterine wall or problems related to the distension fluid. Expected benefits and possible risks are discussed beforehand.
Removing a cervical polyp
Small polyps protruding from the cervix can usually be removed during an examination by gently twisting them off at the base with forceps. This takes a short time and usually needs no anaesthesia. Polyps higher in the canal or with a broad base may require hysteroscopy.
The role of medication
Hormonal medication may reduce bleeding in some cases but does not permanently remove an existing polyp. For women taking tamoxifen, a hormone-releasing intrauterine system may be considered to reduce new polyp formation, in agreement with the oncologist.
Recovery
Mild cramping and light bleeding for a few days after hysteroscopic polypectomy are normal, and simple painkillers are usually enough. Most women return to normal activities the next day. To reduce infection risk, avoiding intercourse, tampons, swimming pools and baths while bleeding may be advised. Seek medical advice for fever, foul-smelling discharge, increasing pain or heavy bleeding.
The pathology result usually takes from a few days to two weeks and is reviewed at the follow-up visit. For women trying to conceive, when to start trying or begin planned treatment is agreed with the doctor; a long wait is usually not needed.
Do polyps come back?
A polyp completely removed at its base rarely regrows in the same place, but new polyps can develop elsewhere in the lining over time. Reported recurrence rates vary widely and are higher with multiple polyps, tamoxifen use and ongoing oestrogen stimulation. If bleeding recurs, assessment is repeated.
When should you see a doctor?
- Spotting or bleeding between periods
- Periods that have become noticeably heavier or longer
- Bleeding after intercourse
- Any bleeding or spotting after menopause
- Unexpected bleeding while taking tamoxifen
- No pregnancy after one year (six months if 35 or over) of regular intercourse
Frequently Asked Questions
Do uterine polyps go away on their own?
Is a uterine polyp cancer?
Do I need general anaesthesia to have a polyp removed?
Do polyps stop you getting pregnant?
When can I try to conceive after polyp removal?
Do I still need cervical screening if I have a cervical polyp?
Sources
- American Association of Gynecologic Laparoscopists (AAGL). AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol, 2012.
- Bougie O, et al. Guideline No. 447: Diagnosis and Management of Endometrial Polyps. J Obstet Gynaecol Can, 2024.
- Royal College of Obstetricians and Gynaecologists. Outpatient Hysteroscopy (Green-top Guideline No. 59), 2nd ed. BJOG, 2024.
- American College of Obstetricians and Gynecologists. Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol, 2018 (reaffirmed 2023).
- American College of Obstetricians and Gynecologists. Abnormal Uterine Bleeding. Patient FAQ.
The information on this website is for general information only and does not replace a medical consultation.