Endometrial polyps, also known as uterine polyps, are growths that develop from the inner lining of the uterus, called the endometrium. They may occur as a single polyp or as multiple growths and can vary considerably in size. Most endometrial polyps are benign, although in a small number of cases precancerous or cancerous changes may be present.
Many women with endometrial polyps have no symptoms, while others may experience irregular periods, heavy menstrual bleeding, bleeding between periods or bleeding after menopause. Endometrial polyps may also be associated with infertility, which makes their assessment particularly important in women who are trying to conceive or undergoing fertility treatment.
Diagnosis usually involves imaging of the uterine cavity, while hysteroscopy allows the doctor to directly examine the inside of the uterus and, when necessary, remove a polyp during the same procedure.
What Are Endometrial Polyps?
Endometrial polyps are growths that arise from the endometrium, the tissue that lines the inside of the uterus. They extend into the uterine cavity and may appear as a single polyp or as multiple polyps.
Their size can vary considerably. Some are only a few millimetres in diameter, while others may grow to several centimetres. They can be attached to the uterine wall by a broad base or by a thin stalk.
Most endometrial polyps are benign, meaning they are not cancerous. However, because precancerous or malignant changes can occasionally be found within a polyp, tissue removed during treatment is usually sent for histological examination.
What Causes Endometrial Polyps?
The exact cause of endometrial polyps is not completely understood. However, hormonal factors appear to play an important role, particularly oestrogen, as endometrial tissue responds to changes in hormone levels.
Endometrial polyps are more commonly diagnosed in women approaching menopause or after menopause, although they can also occur in younger women.
Several factors have been associated with an increased likelihood of developing uterine polyps, including:
- obesity,
- high blood pressure,
- hormonal changes,
- the use of tamoxifen for breast cancer treatment,
- certain types of hormone therapy.
Having one or more of these factors does not necessarily mean that a woman will develop endometrial polyps. Each case should be evaluated individually according to the woman’s age, symptoms and medical history.
Symptoms and Diagnosis of Endometrial Polyps
Endometrial polyps do not always cause symptoms. Some women may only discover that they have a uterine polyp during a routine gynaecological examination or an ultrasound performed for another reason.
When symptoms are present, abnormal uterine bleeding is one of the most common signs. Symptoms may include:
- irregular menstrual periods,
- heavy menstrual bleeding,
- bleeding or spotting between periods,
- bleeding after menopause,
- unpredictable vaginal bleeding.
In some women, endometrial polyps may also be identified during the investigation of infertility.
How Are Endometrial Polyps Diagnosed?
The investigation usually begins with a transvaginal ultrasound, which allows the doctor to examine the uterus, endometrium and uterine cavity. A polyp may appear as an area of thickened endometrial tissue or as a distinct growth within the cavity.
When further evaluation is required, sonohysterography may be used. During this examination, fluid is introduced into the uterine cavity, helping to provide a clearer ultrasound image of the endometrium and any possible polyps.
Hysteroscopy provides direct visualisation of the inside of the uterus. A thin instrument equipped with a camera is passed through the vagina and cervix into the uterine cavity, allowing the doctor to identify endometrial polyps and other abnormalities. An important advantage of hysteroscopy is that, when appropriate, a polyp can also be removed during the procedure.
Endometrial Polyps and Fertility
Endometrial polyps may affect fertility in some women, particularly when they alter the shape or environment of the uterine cavity. Their possible impact depends on factors such as their size, number and location.
A polyp may interfere with the normal function of the endometrium or occupy part of the uterine cavity, potentially making embryo implantation more difficult. However, not every woman with an endometrial polyp will experience infertility, and the clinical significance of a polyp should always be assessed individually.
Can Endometrial Polyps Affect Pregnancy?
Women with endometrial polyps can still become pregnant naturally. However, when a polyp is found during an infertility investigation, the doctor may consider whether it could be contributing to difficulties with conception.
The decision to remove a polyp before attempting pregnancy depends on several factors, including:
- the size and location of the polyp,
- whether there is one or more polyps,
- the presence of abnormal bleeding,
- the woman’s age,
- previous fertility history,
- other possible causes of infertility.
Endometrial Polyps Before IVF
Evaluation of the uterine cavity is an important part of fertility assessment before in vitro fertilisation (IVF). If an endometrial polyp is identified before embryo transfer, its size, position and possible effect on the uterine cavity are taken into consideration.
In selected cases, hysteroscopic removal of the polyp may be recommended before IVF or embryo transfer to restore the uterine cavity and address a possible factor that could interfere with implantation.
The approach should always be personalised, as not every small or asymptomatic polyp requires the same treatment before fertility therapy.
How Are Endometrial Polyps Treated?
The treatment of endometrial polyps depends on several factors, including the woman’s age, symptoms, fertility plans, menopausal status and the characteristics of the polyp.
Not every endometrial polyp requires immediate removal. Small polyps that do not cause symptoms may sometimes be monitored, particularly in women with a low risk of malignancy. However, treatment may be recommended when a polyp causes abnormal bleeding, is associated with infertility, appears suspicious or is found after menopause.
Hysteroscopic Polypectomy
Hysteroscopic polypectomy is the preferred method for removing endometrial polyps because it allows the doctor to see the uterine cavity directly and remove the polyp in a targeted way.
During the procedure, a thin hysteroscope is passed through the vagina and cervix into the uterus. The polyp is identified and removed using specialised instruments, without the need for abdominal incisions.
One of the main advantages of hysteroscopy is that it allows both diagnosis and treatment during the same procedure. The removed tissue is usually sent for histological examination to confirm the diagnosis and exclude abnormal cellular changes.
Compared with blind curettage, hysteroscopic removal offers greater precision because the polyp is removed under direct visualisation.
What Happens After Polyp Removal?
Recovery after hysteroscopic polypectomy is usually quick. Some women may experience mild cramping, light bleeding or spotting for a short period after the procedure.
The doctor will provide individual instructions regarding:
- physical activity,
- sexual intercourse,
- use of tampons,
- follow-up appointments,
- when attempts to conceive can resume,
- when fertility treatment or embryo transfer can continue.
For women undergoing fertility treatment, the timing of the next step depends on the hysteroscopic findings, the histology results and the individual treatment plan.
Frequently Asked Questions About Endometrial Polyps
Are endometrial polyps cancerous?
Most endometrial polyps are benign. However, a small proportion may contain precancerous or cancerous cells. For this reason, polyps that are removed are usually sent for histological examination, particularly when there are additional risk factors or abnormal bleeding.
Can an endometrial polyp disappear on its own?
Some small endometrial polyps, particularly in premenopausal women without symptoms, may regress without treatment. In selected cases, the doctor may therefore recommend monitoring rather than immediate removal.
Can uterine polyps cause heavy bleeding?
Yes. Endometrial polyps can cause heavy menstrual bleeding, irregular periods, bleeding between periods or spotting. Bleeding after menopause should always be medically evaluated.
Can I get pregnant if I have an endometrial polyp?
Yes. Having an endometrial polyp does not necessarily prevent pregnancy. However, uterine polyps have been associated with infertility and may, in some cases, interfere with the environment of the uterine cavity or embryo implantation. Their significance depends on factors such as size, location and the woman’s fertility history.
Should an endometrial polyp be removed before IVF?
Not every endometrial polyp automatically needs to be removed before IVF. The decision depends on the size and location of the polyp, whether it affects the uterine cavity, the presence of symptoms and the woman’s previous fertility history. The approach should therefore be individualised after assessment by a fertility specialist.
How are endometrial polyps removed by hysteroscopy?
During hysteroscopic polypectomy, a thin hysteroscope is introduced through the vagina and cervix into the uterus. This allows the doctor to see the polyp directly and remove it using specialised instruments. The procedure does not require abdominal incisions, and the removed tissue can then be sent for histological examination.
