Endometrial Polyps: Common Growths in the Uterus
Endometrial polyps are one of the most commonly encountered gynecologic findings, especially when someone is being evaluated for abnormal uterine bleeding. They’re often found incidentally on ultrasound or during a workup for irregular spotting, heavier periods, or bleeding after sex. While hearing the word “polyp” can feel alarming, most endometrial polyps are benign and very treatable. Understanding what they are, how they’re diagnosed, and when they might need treatment can take a lot of the fear out of the process.
What Is an Endometrial Polyp?
An endometrial polyp is a soft overgrowth of the endometrial lining - the tissue that lines the inside of the uterus (and what sheds when you have your period). It’s made of a similar type of tissue as the normal uterine lining, but instead builds up too much in one area and forms a protruding structure. A helpful way to think about it is like a skin tag inside the uterus.
Some polyps are flat, while others grow on a thin stalk. They can be small or large, and some people have just one while others have several.
Endometrial polyps are different from fibroids. Fibroids come from the muscle layer of the uterus, whereas polyps arise from the lining itself.
Why Endometrial Polyps Can Cause Bleeding
Polyps interrupt the normally smooth surface of the uterine lining. Because they’re fragile and have their own blood supply, they can bleed more easily than surrounding tissue. They can also interfere with how the lining sheds during a menstrual cycle.
Common bleeding patterns associated with polyps include spotting between periods, heavier or longer-than-usual periods, bleeding after sex, and postmenopausal bleeding.
An important point to know is that polyps can cause bleeding even when hormone cycles are otherwise normal. Having regular periods or “normal” hormone levels doesn’t rule them out.
Who Gets Endometrial Polyps?
Endometrial polyps can occur at any age after menstrual cycles begin, but they become more common with increasing age, particularly during perimenopause and after menopause. Certain factors are associated with a higher likelihood of developing polyps, including higher lifetime estrogen exposure (such as with PCOS), obesity, and use of medications like tamoxifen. That said, many people develop polyps without any clear risk factors at all. Having a polyp doesn’t mean you did anything wrong.
How Are Endometrial Polyps Diagnosed?
Most polyps are discovered during an evaluation for abnormal bleeding.
A pelvic ultrasound is often the first test performed. It may show a focal thickening or a mass within the uterine lining. Sometimes, ultrasound can even show blood flow feeding the polyp through its stalk, which can make the diagnosis more suggestive - but ultrasound isn’t always definitive.
A saline infusion sonogram, sometimes called a “water ultrasound,” uses fluid to gently outline the uterine cavity. This makes polyps easier to see and is often used when ultrasound findings are unclear.
An endometrial biopsy is not typically used to diagnose polyps directly. Because a biopsy samples tissue blindly, it can miss focal growths like polyps. However, if a biopsy is done for another reason and shows abnormal tissue, it may raise suspicion that a polyp is present, which usually leads to further evaluation.
Hysteroscopy is considered the gold standard for diagnosis. A small camera is inserted into the uterus, allowing direct visualization of the cavity. This approach often allows diagnosis and treatment to happen at the same time.
Are Endometrial Polyps Cancerous?
The vast majority of endometrial polyps are benign. A small percentage can contain precancerous or cancerous cells. Overall, the risk of cancer within a polyp is low, but it is higher in postmenopausal patients and in people with persistent abnormal bleeding or certain risk factors, such as increasing age, obesity, or tamoxifen use.
Most polyps are not cancer, but abnormal bleeding should always be evaluated to rule out more serious causes.
Do Endometrial Polyps Always Need to Be Removed?
Not always. If a polyp is causing symptoms like bleeding or pain, removal is usually recommended. Polyps are also commonly removed in people with fertility concerns, postmenopausal bleeding, or imaging findings that are concerning.
In premenopausal patients without symptoms, small polyps can sometimes be monitored. In some cases, they may even resolve on their own as the uterine lining sheds naturally, though this isn’t something that can be predicted in advance.
How Are Endometrial Polyps Treated?
When treatment is needed, polyps are most commonly removed using hysteroscopic polypectomy. This is a minimally invasive procedure performed with a camera inside the uterus. Depending on the situation, it can be done in the office or in the operating room.
This is not the same as a full D&C, which involves broader scraping of the uterine lining. In some cases, a D&C may be performed at the same time as polyp removal, depending on the clinical scenario, but many polyps can be removed precisely without it.
Recovery is usually quick, and most people go home the same day.
Can Polyps Come Back?
Yes, polyps can recur. Removing a polyp treats the growth that’s there, but it doesn’t necessarily change the underlying tendency to form them. Some people never develop another polyp, while others may experience recurrence over time.
Endometrial Polyps and Fertility
Endometrial polyps can interfere with implantation and early pregnancy development. For some people, especially those undergoing fertility treatment or experiencing unexplained infertility, removing a polyp may improve the chances of conception.
A Note on Cervical Polyps
Sometimes, a polyp that appears to be coming from the cervix actually originates higher up in the uterus and extends downward. Other times, the polyp truly arises from the cervix itself. Cervical polyps behave very similarly to endometrial polyps and can cause spotting or bleeding after sex.
The key difference is that cervical polyps are often easier to manage. Many can be removed in the office during a routine pelvic exam, without the need for more invasive procedures.
The Bottom Line
Endometrial polyps are common, usually benign growths of the uterine lining and a frequent cause of abnormal bleeding. While they can be unsettling to hear about, most are straightforward to evaluate and treat. If you’re experiencing abnormal bleeding, getting checked - and asking questions - is the first step toward clarity and relief.
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