Endometrial Polyps and Treatment

An endometrial polyp is soft tissue projecting into the uterine cavity after overgrowth of part of your uterine lining (endometrium). Most polyps are benign, and some cause no symptoms. Your doctor decides treatment according to symptoms, age, menopause, risk factors and pregnancy plans; not every polyp is managed in the same way. This information is general, not individual diagnostic or treatment advice.

What is an endometrial polyp?

The endometrium is the layer that thickens during the menstrual cycle and is shed with a period. A polyp forms through localised overgrowth of its glandular and supporting tissue. There may be one or several polyps, ranging from very small to quite large. A polyp is usually benign. However, a small number contain atypical cells or malignant changes, which makes pathology examination of removed polyps important.

What symptoms can an endometrial polyp cause, and who is more likely to develop one?

The most common symptom is abnormal uterine bleeding. This may be bleeding or spotting between periods, irregular periods, heavier-than-usual periods or bleeding after menopause. In some people, a polyp is found incidentally during ultrasound or hysteroscopy without any symptoms. A polyp may also be found during assessment of difficulty conceiving in someone planning pregnancy.

Polyps occur during reproductive life and after menopause. Medicines such as tamoxifen, excess weight, diabetes or hypertension may warrant closer assessment for polyps and related endometrial problems. Bleeding is not always caused by a polyp; other causes can produce the same symptom and need assessment.

How is an endometrial polyp diagnosed?

Assessment begins with a detailed history and examination. Transvaginal ultrasound is usually the first imaging test during reproductive life. Saline infusion sonography using sterile fluid inside the uterine cavity, or colour Doppler, may clarify a suspected polyp. Hysteroscopy directly views the cavity with a camera and is a reliable method for diagnosis and treatment. Blind tissue sampling alone is insufficient for bleeding symptoms, as polyps may be missed.

When a polyp is removed, examination of the tissue in a pathology laboratory establishes the definitive diagnosis. Not every image resembling a polyp on ultrasound is a polyp: other structures, such as a submucosal fibroid, can look similar. The doctor makes this distinction.

How is an endometrial polyp treated?

When is monitoring preferred?

Immediate removal may not be necessary in people of reproductive age who have no symptoms and are at low risk; some polyps may shrink on their own over time. Monitoring aims to track new symptoms or a significant change in the polyp. The doctor decides which polyps can be monitored according to size, symptoms, age, risk factors and pregnancy plans. There is no single criterion.

Can medicines remove a polyp?

No. Medicines do not remove polyps. Hormonal or other medicines may ease bleeding, but do not treat the polyp itself. Removal is often considered if the polyp is thought to cause bleeding.

How is hysteroscopic polypectomy performed?

Polypectomy means removing a polyp from the uterine cavity using hysteroscopy. It does not require an abdominal incision: a thin camera and an instrument are passed through the vagina and cervix. Whether it takes place in an office setting or an operating theatre depends on the polyp's features and the individual. Risks include infection, bleeding and, rarely, perforation of the uterine wall. The doctor explains these beforehand. A polyp may recur in the same area or elsewhere in the womb.

Blind curettage, which was frequently used in the past, is inadequate for complete polyp removal and intervention under direct vision. Hysteroscopy is therefore now the preferred approach.

What happens to the removed tissue?

Removed tissue is always sent for pathology examination. A benign result generally requires no further treatment. If atypical cells or malignant changes are found, follow-up and treatment are replanned according to the result, with referral to a gynaecological oncologist if needed.

What does a polyp mean if you are planning pregnancy?

Because of their location in the uterine cavity, polyps are thought to be capable of adversely affecting embryo implantation. Removal is often discussed for people with polyps who are planning pregnancy. However, benefit from routinely removing every polyp found in every person unable to conceive has not been proven. Polypectomy is considered in selected situations, such as symptomatic, apparently large or recurrent polyps found during assessment before IVF. The doctor makes the decision together with pregnancy plans and treatment timing.

What happens if a polyp is found after menopause?

If bleeding develops after menopause and ultrasound shows a polyp, hysteroscopic removal and pathology examination are generally recommended. This is because serious endometrial problems need to be ruled out as the cause of bleeding in this group. In a low-risk postmenopausal person without bleeding, monitoring or removal is assessed according to risk factors.

Bleeding after menopause needs assessment even if brief and light. A normal smear or HPV result does not remove the need to assess the womb lining, because these tests screen the cervix rather than assessing the endometrium.

What should you pay attention to after treatment?

Light bleeding or spotting may occur after polypectomy. The doctor explains how long symptoms may last and how to monitor them. The timing of return to normal daily activities depends on the procedure and the individual. A polyp may recur; new bleeding, a change in menstrual pattern or other new symptoms need review. The doctor decides when to perform follow-up ultrasound in someone without symptoms.