Uterine polyps are growths that occur in the womb (uterus) and may cause irregular vaginal bleeding. Sometimes, they are picked up incidentally during an examination or at a pelvic scan.
Uterine polyps can occur at any age but occur more frequently during the perimenopause and menopause. Polyps are very common occurring in 1 in 10 women. They are found more often in women with abnormal bleeding. Polyps are usually benign but sometimes they may be precancerous or cancerous. That is why all polyps that are removed are analysed to check they are not of a sinister nature.
Types of polyps:
Endometrial polyps are soft growths occurring as a result of the thickening of the lining of the womb (endometrium) caused by overgrowth of cells. These are the commonest type and if very small, may resolve on their own in younger patients.
Fibroid polyps tend to be firm benign growths of muscle which usually need surgical removal if causing symptoms.
Endocervical polyps arise from the cervix (neck of the womb) and may cause bleeding after sex or may be picked up on a routine check such as a cervical smear examination. They can often be treated in the clinic itself, with minimal discomfort.
Placental polyps are uncommon and occur as a result of a bit of placenta being left behind at childbirth that may then develop its own blood supply and cause bleeding, sometimes very heavy. Surgical treatment is needed to remove this kind of polyp.
Symptoms of polyps:
Polyps may cause no symptoms and may be discovered incidentally. They may be more than one in the uterine cavity and depending on their size (ranging from a few mm to the size of a plum) polyps may be responsible for heavy periods, intermenstrual bleeding (spotting or heavy bleeding in between periods), irregular bleeding, post-menopausal bleeding, difficulty in conceiving and some early miscarriages.
In some women, polyps may make it more difficult in getting pregnant as a polyp can act like a foreign body in the womb in this situation. If a polyp protrudes out of the cervix, it can cause bleeding after sex. Polyps usually do not cause pain.
What causes polyps?
Hormones especially an excess of circulating oestrogen, hormone replacement therapy (HRT), being overweight or on Tamoxifen chemotherapy are implicated in some polyps developing although in many cases, no obvious cause is found.
What to look out for:
Seek medical advice urgently if you are having bleeding after menopause, bleeding after sex or unscheduled or heavy bleeding or if you are concerned.
Management of polyps:
Polyps are removed by a simple minimally invasive procedure called hysteroscopy (see separate leaflet on Hysteroscopy) through the vagina, using a surgical instrument with a telescope and camera at the end, either under local or a short general anaesthetic. There are no other options other than surgery once a polyp is diagnosed.
Watchful waiting is usually not recommended except on an individual basis after specialist input. There are no alternative methods of treating polyps. However, a progesterone containing coil (Mirena IUS) may help in preventing recurrent polyps by thinning the lining. Polyps may return especially if they are as a result of excess oestrogen stimulating the lining and women then sometimes need repeat surgery.
Women should have lifestyle guidance including nutrition advice to help reduce weight and thereby reduce endogenous oestrogen levels, lowering the risk of polyps developing into precancer or cancer. See nutrition leaflet.
Dr Nitu Bajekal, FRCOG Dip IBLM
Consultant Gynaecologist and Women’s Health Expert
Updated January 2020