Endometrial Polyps: Symptoms, Tests and Treatment

Endometrial polyps are growths from the uterine lining that may cause irregular bleeding or no symptoms.

Also called uterine or womb polyps, they project into the cavity of the uterus and may attach by a broad base or a stalk. Most are non-cancerous, but examination of removed tissue can identify uncommon precancerous or cancerous changes that cannot be confirmed from symptoms alone.

Endometrial polyps commonly present with bleeding between periods, unpredictable spotting, heavy menstrual bleeding or bleeding after menopause. Bleeding may also occur after sex. These patterns can have several causes, so symptoms guide investigation rather than proving that a polyp is present.

Some polyps are found during imaging or fertility assessment without causing any symptoms. Pelvic pain is not a typical defining feature; severe pain, faintness, fever, pregnancy-related bleeding or very heavy bleeding needs prompt assessment for other urgent causes.

A polyp begins when an area of the endometrium grows more than the surrounding uterine lining. Glands, connective tissue and blood vessels form the projection into the cavity. Hormonal stimulation, particularly oestrogen activity, is thought to influence this growth.

The exact trigger for an individual polyp is usually unclear. It is different from a fibroid, which grows from uterine muscle, although both can produce abnormal bleeding and may appear during the same investigation.

A polyp may remain stable, cause intermittent bleeding, or sometimes regress. Symptoms can fluctuate because the uterine lining changes through the menstrual cycle and because a polyp's surface can bleed unpredictably.

Follow-up depends on bleeding, menopausal status, fertility plans, ultrasound appearance and tissue results if sampling or removal occurs. Reassessment is appropriate if bleeding returns after treatment or develops after menopause.

Polyps are seen more often around and after the menopausal transition. Other associations include obesity, high blood pressure and exposure to medicines that alter oestrogen activity, such as tamoxifen. Having an association does not mean a polyp will form.

A clinician considers these factors when deciding whether to observe, sample or remove a suspected polyp. Bleeding after menopause warrants assessment regardless of known risk factors because several conditions can cause it.

The assessment starts with the bleeding pattern, medicines, pregnancy possibility, contraceptive use, menopausal status and relevant health history. A pelvic examination may look for bleeding from the cervix or vagina. Blood tests may be used when heavy bleeding could have caused anaemia.

Transvaginal ultrasound can show a focal area within the uterine cavity. Saline infusion during ultrasound may outline the cavity more clearly. Diagnostic hysteroscopy passes a slim camera through the vagina and cervix, allowing direct inspection; a biopsy or removal may be performed at the same visit when appropriate.

A small polyp without symptoms may sometimes be observed after an individual clinical assessment. Removal is more likely to be recommended for troublesome bleeding, bleeding after menopause, fertility-related concerns, an uncertain appearance, or when tissue analysis is needed.

Hysteroscopic polypectomy removes the growth through the cervix while the clinician views the uterine cavity. It avoids an abdominal incision and may take place in an outpatient or operating-room setting, depending on the polyp, available pain control and patient preference. Removed tissue is generally sent for laboratory examination.

Keep a record of bleeding days, flow, pain, bleeding after sex and any missed medicines. Bring a medicines list to appointments, including hormonal treatment, blood-thinning medicine and tamoxifen. If fatigue, breathlessness or dizziness accompanies heavy bleeding, mention these possible signs of anaemia.

Before hysteroscopy, ask which pain-relief choices are available and whether treatment can occur during the same visit. After polyp removal, follow instructions on pads, bathing, exercise and sex. Seek review for worsening abdominal pain, fever, unpleasant-smelling discharge or bleeding that becomes heavier rather than settling.

Ongoing blood loss can contribute to iron deficiency or anaemia, while irregular bleeding can affect sleep, work, exercise and sexual wellbeing. Some polyps may interfere with embryo implantation, although fertility has many possible influences and needs individual assessment.

Hysteroscopy and removal can cause cramping and short-term bleeding. Less common problems include infection, heavier bleeding, injury to the cervix or a small perforation of the uterine wall. Your care team should explain warning signs and how to contact the service after the procedure.

There is no established method that reliably prevents endometrial polyps. Do not stop prescribed hormonal or cancer-related medicines to try to reduce risk; discuss abnormal bleeding with the prescriber so benefits, risks and investigation can be considered together.

A new polyp can develop after a previous one is removed. Recording recurrent bleeding and attending recommended follow-up helps clinicians distinguish recurrence from other causes of uterine bleeding.

A gynaecologist or clinician trained in hysteroscopy can evaluate a suspected endometrial polyp. Look for a service able to provide pelvic ultrasound, direct cavity assessment, tissue sampling and hysteroscopic removal when indicated.

At booking, state whether bleeding occurs after menopause, between periods, after sex or despite hormonal treatment. Also mention pregnancy possibility, severe symptoms, anticoagulant use and previous uterine procedures because these details can change the timing and setting of care.