Uterine Polyps: What Causes Them, How They're Found, and When Doctors Recommend Removal

Uterine polyps (also called endometrial polyps) are small, benign growths that develop on the lining of the uterus (endometrium). They vary in size—from a few millimeters to several centimeters—and may occur as single polyps or in clusters. While most uterine polyps are noncancerous, they can cause symptoms that affect your quality of life or raise concerns about fertility and rare risks of cancerous change.

What Causes Uterine Polyps?

The exact cause of uterine polyps isn't fully understood, but several factors seem to play a role:

• Hormonal imbalances
– Estrogen stimulates the uterine lining. High local levels of estrogen or increased sensitivity to it can encourage polyp growth.
– Progesterone fluctuations may also contribute.

• Age and reproductive history
– Polyps are more common in women aged 40–50, around perimenopause.
– They can occur in younger women, especially if risk factors are present.

• Medical conditions
– Obesity and metabolic syndrome can alter hormone levels.
– High blood pressure (hypertension) and polycystic ovary syndrome (PCOS) have been linked.
– Tamoxifen use (for breast cancer) may increase the chance of polyps.

• Genetics and inflammatory factors
– A family history of endometrial abnormalities may play a part.
– Chronic inflammation inside the uterus (endometritis) could encourage local overgrowth of cells.

How Uterine Polyps Are Detected

Some uterine polyps cause no symptoms and are discovered during routine check-ups or fertility evaluations. When symptoms do occur, they often involve changes in menstrual bleeding or discomfort. Common signs include:

• Irregular menstrual bleeding
• Bleeding between periods
• Heavy periods (menorrhagia)
• Spotting after menopause
• Infertility or repeated miscarriage

Rarely, polyps cause painless abnormal vaginal discharge. If you're experiencing unusual discharge or other concerning changes, Ubie's free Abnormal vaginal discharge symptom checker can help you better understand your symptoms and decide whether to see a doctor.

Diagnostic Tests

To confirm the presence of polyps and assess their size, number, and location, your doctor may recommend:

• Transvaginal ultrasound
A probe inserted into the vagina uses sound waves to create images of the uterine lining. It can show thickened areas suggestive of polyps.

• Saline infusion sonohysterography
Also known as an "SIS," this involves injecting sterile saline into the uterus during ultrasound for clearer images of polyps.

• Hysteroscopy
A thin, lighted tube (hysteroscope) is inserted through the cervix into the uterus. It allows direct visualization and, in many cases, immediate removal of small polyps.

• Endometrial biopsy
A small sample of the uterine lining is removed to rule out precancerous or cancerous changes.

When Doctors Recommend Removal

Not all uterine polyps require immediate removal. Your healthcare provider will consider:

• Symptom severity
– Heavy or irregular bleeding that affects daily life
– Persistent spotting or discharge

• Size and number of polyps
– Large polyps (>1 cm) are more likely to cause bleeding and pain
– Multiple polyps may increase risk of abnormal bleeding

• Fertility concerns
– Polyps can interfere with embryo implantation or contribute to miscarriage
– Removal may improve fertility outcomes in women trying to conceive

• Postmenopausal status
– Any uterine polyp in a woman who has gone through menopause warrants evaluation, since the risk of cancerous change is higher than in premenopausal women.

• Suspicion of cancer
– If imaging or biopsy suggests atypical cells, prompt removal and further testing are needed.

Polyp Removal Procedures

Several techniques are available, chosen based on polyp size, location, and clinical setting:

1. Hysteroscopic Polypectomy

   • Performed in an operating room or outpatient setting.
   • A hysteroscope guides small instruments to cut and remove polyps under direct vision.
   • Allows precise removal with minimal damage to healthy tissue.

2. Dilatation and Curettage (D&C) with Hysteroscopic Guidance

   • The cervix is gently dilated to allow passage of instruments.
   • Curettes scrape away abnormal tissue, often paired with hysteroscopy for visualization.

3. Office-Based Hysteroscopy

   • Smaller hysteroscopes make polypectomy possible in a doctor's office without general anesthesia.
   • Recovery is swift; most women go home the same day.

What to Expect After Removal

• Recovery
– You may experience mild cramping or light bleeding for a few days.
– Over-the-counter pain relievers and rest typically suffice.

• Follow-up
– A pathology report on the removed tissue confirms whether polyps were benign.
– Repeat ultrasound or hysteroscopy may be scheduled if symptoms recur.

• Risks
– Infection (rare)
– Uterine perforation (very rare with experienced hands)
– Scar tissue formation (Asherman's syndrome), which is uncommon after small polyp removal

Living with Uterine Polyps and Prevention

While you can't guarantee polyps will never develop again, these steps may help lower your risk or catch them early:

• Regular gynecologic check-ups, especially if you have risk factors
• Managing chronic conditions like hypertension and obesity
• Monitoring menstrual changes and seeking evaluation for abnormal bleeding
• Discussing hormonal treatments (e.g., low-dose progesterone IUD) if recommended by your doctor

When to Speak to a Doctor

Although uterine polyps are usually benign, certain signs demand prompt medical attention:

• Very heavy bleeding soaking more than one pad or tampon per hour
• Severe pelvic pain or fever (possible infection)
• Any sudden, unusual changes in vaginal discharge or bleeding patterns
• Symptoms of anemia—such as extreme fatigue, dizziness, or shortness of breath

Always speak to a doctor about anything that could be life-threatening or serious. Early evaluation and management of uterine polyps can ease symptoms, preserve fertility, and rule out more serious conditions. If you have concerns about abnormal vaginal discharge, bleeding, or pelvic discomfort, don't hesitate to seek professional advice or check your symptoms using Ubie's free Abnormal vaginal discharge symptom checker.