Uterine Polyps

Overview

What are uterine polyps?

Uterine polyps are growths in the inner lining of your uterus (endometrium). They’re sometimes called endometrial polyps.

Uterine polyps form when there’s an overgrowth of endometrial tissue. The polyp attaches to the endometrium by a thin stalk or a broad base and extends into your uterus. Polyps may be round or oval and range in size from a few millimeters (the size of a sesame seed) to a few centimeters (the size of a golf ball) or larger. You may have one or several polyps present.

Uterine polyps are usually benign (noncancerous), but they may cause problems with periods (menstruation) or your ability to have children (fertility).

uterine polyputerine polyp

Who is affected by uterine polyps?

Age is a major predictor of polyps. You’re most likely to develop uterine polyps in your 40s and 50s, around the time when you’re approaching menopause (perimenopause). Uterine polyps can occur after menopause (postmenopause), but they rarely affect people under 20 years old.

Your chance of developing uterine polyps also increases if you:

You’re at greater risk of getting uterine polyps if you have Lynch syndrome or Cowden syndrome.

Are uterine polyps common?

It’s difficult to tell. Uterine polyps are sometimes asymptomatic, meaning they don’t cause symptoms. For this reason, many people with uterine polyps may never receive a diagnosis. Research does suggest that polyps are more common in certain populations. For instance, they’re more common in people who’ve gone through menopause than those who haven’t.

Symptoms and Causes

What are the symptoms of uterine polyps?

The most common symptom of uterine polyps is abnormal bleeding. Abnormal bleeding includes vaginal bleeding after menopause and irregular menstrual periods. Most periods last four to seven days. Normal menstrual cycles usually occur every 28 days but can range from 21 days to 35 days. Many people with uterine polyps have irregular periods.

The symptoms of uterine polyps include:

  • Irregular menstrual periods (unpredictable timing and flow).
  • Unusually heavy flow during menstrual periods (heavy menstrual bleeding).
  • Bleeding or spotting between periods (intermenstrual bleeding).
  • Infertility (being unable to become pregnant or carry a pregnancy to term).
  • Vaginal spotting or bleeding after menopause (red, pink or brown blood).
  • Bleeding after intercourse.

Your healthcare provider may discover asymptomatic polyps during a procedure to diagnose a separate issue. Polyps can sometimes prolapse, or slip, through your cervix. The cervix is the opening between your vagina and your uterus. In these instances, your provider may be able to see the polyp during a physical exam.

Are uterine polyps painful?

Large polyps can sometimes cause dull aching in your abdomen or lower back, similar to menstrual cramps. Pain isn’t a common symptom of uterine polyps, though.

What causes uterine polyps?

Researchers don’t know why polyps form, but hormone levels may be a factor. Estrogen plays a role in causing the endometrium to thicken each month during your menstrual cycle. This thickening likely contributes to uterine polyp growth. Many risk factors for uterine polyps involve your body being exposed to high amounts of estrogen.

Diagnosis and Tests

[h3] How are uterine polyps diagnosed?

Your healthcare provider will review your medical history and ask questions about your symptoms. If you’re postmenopausal, your provider may ask if you’ve noticed any bleeding or spotting. They’ll likely ask what medicines you’re taking. If you still get your periods, they may ask about the specifics of your menstrual cycle, including how long your periods last and how often you have them. Your provider may ask if you’ve had difficulty getting pregnant.

Your provider will also perform a gynecological exam, including a pelvic exam and a Pap smear. They may order additional tests or procedures to confirm that the growths are polyps.

These tests may include:

  • Transvaginal ultrasound: Your provider inserts a slim handheld device called an ultrasound transducer into your vagina. The device emits sound waves that provide an image of the inside of your uterus, including any irregularities that may be present.
  • Sonohysterography: After your initial transvaginal ultrasound, your provider may send a sterile fluid into your uterus through a thin tube called a catheter. The fluid causes your uterus to expand, providing a clearer image of any growths within your uterine cavity during the ultrasound procedure.
  • Hysteroscopy: Your provider inserts a long, thin tube with a lighted telescope (hysteroscope) through your vagina and cervix into your uterus. The hysteroscope allows your provider to examine the inside of your uterus. Hysteroscopy is sometimes used in combination with surgery to remove uterine polyps.
    Illustration - a long metal instrument called a curette to collect tissue from the inner walls of the uterus | Cleveland Clinic
  • Endometrial biopsy: Your provider uses a soft plastic instrument to collect tissue from the inner walls of your uterus. The sample is tested in a laboratory to detect any abnormal cells.
  • Curettage: Your provider uses a long metal instrument called a curette to collect tissue from the inner walls of your uterus. The curette has a small loop on the end that's used to scrape tissue or polyps. The tissue or polyps that are removed may be sent to the laboratory for testing to determine if cancer cells are present.

Management and Treatment

How are uterine polyps treated?

Treatment will depend on your symptoms and other factors that increase your risk of uterine cancer. If you’re still in your reproductive years and the polyp isn’t causing symptoms, your provider may monitor it instead of treating it. The polyp may go away on its own. If you’ve gone through menopause and/or if polyps are causing symptoms, you may need treatment.

Methods of treatment include:

  • Medications: Drugs that keep your hormones balanced, like progestins or gonadotropin-releasing hormone agonists, may be used to relieve symptoms. The symptoms usually return after you stop taking the medication.
  • Uterine polypectomy: Your provider will likely be able to remove your polyp during hysteroscopy. A hysteroscope allows your provider to insert tools that can be used to excise (cut) and remove polyps. The advantage of hysteroscopy is that it’s precise. Your provider can visualize your polyp and remove it at the same time. They can then send the tissue to a lab for testing to check for signs of cancer.

You may need additional surgery if a polyp is cancerous. A hysterectomy, a surgery that involves removing your uterus, may be necessary in cases where the polyps contain cancer cells.

Do uterine polyps need to be removed?

It depends. If you’re pre-menopausal and not experiencing symptoms, the polyp is considered to be low risk. It may not need to be removed. If you’re postmenopausal or experiencing symptoms like abnormal bleeding, your provider may recommend removal. Your provider may also remove polyps if they could cause problems during pregnancy or negatively impact your fertility.

Is uterine polyp removal painful?

Your provider will give you medications beforehand to prevent you from feeling pain during surgery. You still may feel slight pulling or pressure.

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Prevention

Can uterine polyps be prevented?

You can’t prevent uterine polyps. You can take steps to catch them early so that they don’t cause complications or unpleasant symptoms. Getting regular gynecological checkups can allow your provider to catch polyps early.

Outlook / Prognosis

What can I expect if I have uterine polyps?

The outcomes associated with uterine polyp removal are excellent. Research shows that removing polyps eases symptoms in 75% to 100% of cases. Polyps rarely grow back (recur) after removal. If they do, your provider can recommend treatments. It’s possible that polyp removal can help with fertility issues, but more research is needed to know for sure.

Living With

Should I worry about uterine polyps?

Take comfort in knowing that only a small percentage of uterine polyps become cancerous. If you’re in a group that’s considered at high risk for cancer, your provider can remove the polyp. The risk of complications associated with removal is low.

What percentage of uterine polyps are cancerous?

Only about 5% of uterine polyps are cancerous. Your risk is greater of a polyp being cancerous if you’re postmenopausal or if you’re experiencing abnormal bleeding. In some instances, a benign polyp may closely resemble uterine cancer (endometrial sarcomas) or precancer (endometrial hyperplasia). If there's a question, your provider can perform a biopsy on the tissue to rule out cancer.

When should I see my healthcare provider?

Make an appointment with your provider if you’re experiencing:

  • Vaginal bleeding or spotting after menopause.
  • Vaginal bleeding or spotting when you’re not on your period.
  • Period bleeding that's especially heavy or unpredictable.

What questions should I ask my doctor?

  • Are polyps causing my abnormal bleeding?
  • Am I considered at high risk for polyps becoming cancerous?
  • At what point would you recommend treatment as opposed to monitoring the polyp?
  • Will the polyps affect my ability to become pregnant?
  • Will uterine polyp treatments impact my ability to become pregnant?
  • Will treatment impact my timeline for becoming pregnant?

A note from Cleveland Clinic

Abnormal bleeding may be a sign of uterine polyps — especially if you’re postmenopausal. It can be alarming to have unusual bleeding, but most causes of bleeding (like polyps) are unrelated to uterine cancer. Still, check with your provider to be sure. If your provider is concerned that a polyp can become cancer or if a polyp is causing unpleasant symptoms, they can safely remove it.

Last reviewed by a Cleveland Clinic medical professional on 09/20/2022.

References

  • Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501471/) SAGE Open Med. 2019;7:2050312119848247. Published 2019. May 2. Accessed 9/20/2022.
  • Uglietti A, Buggio L, Farella M, et al. The risk of malignancy in uterine polyps: A systematic review and meta-analysis. (https://pubmed.ncbi.nlm.nih.gov/31009859/) Eur J Obstet Gynecol Reprod Biol. 2019;237:48-56. Accessed 9/20/2022.
  • Vitale SG, Haimovich S, Laganà AS, et al. Endometrial polyps. An evidence-based diagnosis and management guide. (https://pubmed.ncbi.nlm.nih.gov/33756339/) Eur J Obstet Gynecol Reprod Biol. 2021;260:70-77. Accessed 9/20/2022.
  • Vroom AJ, Timmermans A, Bongers MY, van den Heuvel ER, Geomini PMAJ, van Hanegem N. Diagnostic accuracy of saline contrast sonohysterography in detecting endometrial polyps in women with postmenopausal bleeding: systematic review and meta-analysis. (https://pubmed.ncbi.nlm.nih.gov/30693579/) Ultrasound Obstet Gynecol. 2019;54(1):28-34. Accessed 9/20/2022.

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