Uterine Polyps

Uterine polyps are tissue overgrowths that arise from the endometrium, the inner lining of the uterus. Most are benign, but they may cause irregular periods, intermenstrual bleeding, postmenopausal bleeding, and in some patients difficulty conceiving. Polyps detected after menopause or polyps causing symptoms are evaluated more carefully because of the possibility of premalignant or malignant change. ^[1][2][3]

What is a uterine polyp?

A uterine polyp is a localized overgrowth of endometrial tissue. It may be broad-based or attached by a thin stalk projecting into the uterine cavity. Sizes vary from a few millimeters to several centimeters. Some polyps are found incidentally and cause no symptoms, while others disrupt bleeding patterns and affect quality of life. A polyp is not the same thing as cancer, but age, menopausal status, and symptoms influence how it should be managed. ^[1][2][3]

What are the symptoms?

Symptoms may include irregular menstrual bleeding, spotting between periods, heavy bleeding, postmenopausal bleeding, and in some patients infertility or problems with embryo implantation. Some women have no symptoms at all. When bleeding appears after menopause, it should not be dismissed, because endometrial pathology—including but not limited to polyps—requires assessment. ^[1][2][3]

The presence of a polyp does not always explain every bleeding complaint. Nevertheless, structural lesions inside the uterine cavity should be considered when bleeding patterns change or remain unexplained. ^[1][2]

Why do they form, and what are the risk factors?

Uterine polyps are thought to be hormonally responsive, particularly to estrogenic stimulation. Increasing age, the perimenopausal or postmenopausal period, obesity, and some medication-related settings may be associated with risk. However, polyps can also occur in younger patients. ^[1][2][3]

Risk assessment is especially important because most polyps are benign, but a subset—particularly in older patients or in those with postmenopausal bleeding—may harbor premalignant or malignant change. ^[2][3]

How is the diagnosis made?

Diagnosis commonly involves pelvic ultrasound, and in some cases saline infusion sonography or hysteroscopic evaluation may provide more detail. Hysteroscopy is particularly useful because it allows both visualization and removal when needed. ^[1][2]

Definitive assessment often depends on pathologic examination after removal. Imaging may suggest a polyp, but histology determines whether benign, premalignant, or malignant change is present. ^[2][3]

What are the treatment options?

Management depends on symptoms, age, fertility goals, menopausal status, and suspicion of atypia or malignancy. Observation may be reasonable in selected asymptomatic cases, whereas hysteroscopic polypectomy is often recommended for symptomatic polyps, polyps associated with infertility workup, or polyps in higher-risk settings such as postmenopausal bleeding. ^[1][2][3]

Because the pathology result matters, treatment is not only about controlling bleeding. Removal may also clarify diagnosis and guide next steps if atypical or malignant change is found. ^[2][3]

Possible risks and when should you see a doctor?

Medical evaluation is appropriate for intermenstrual bleeding, heavier or prolonged periods, bleeding after menopause, or fertility concerns. Postmenopausal bleeding deserves particularly prompt evaluation because it may be caused by polyps but can also indicate other important endometrial disorders. ^[1][2][3]

How is follow-up performed?

Follow-up depends on symptoms, pathology findings, and whether fertility is a concern. Recurrence can occur, so ongoing unexplained bleeding should not automatically be assumed to be due to a previously known benign polyp. Symptom monitoring and, when needed, repeat imaging may be part of care. ^[1][2]

Why are fertility and pathology results important?

In selected patients, polyps may interfere with implantation or be evaluated during infertility workup. Pathology is equally important because management changes if atypia or malignancy is identified. Therefore, a polyp is not evaluated only as a bleeding problem, but also as a structural lesion that may influence reproductive plans and risk assessment. ^[2][3]

Why can a bleeding diary and follow-up be helpful?

Keeping a record of bleeding days, spotting episodes, and cycle changes can help show whether symptoms are worsening, recurring, or improving after treatment. This makes follow-up more objective and may help determine whether further evaluation is needed. ^[1][2]