Quick answer. Endometrial polyps (uterine polyps) are growths attached to the inner lining of the womb (the endometrium) that extend into the uterine cavity. They are common, particularly around and after menopause, and the large majority are non-cancerous (benign) – though a small proportion can contain precancerous or cancerous cells, more so after menopause. Many cause no symptoms and are found by chance, but they can cause irregular or heavy periods, bleeding between periods or after sex, and – most importantly – bleeding after menopause. The key safety message: any bleeding after menopause must always be checked to exclude womb (endometrial) cancer.
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Polyps are usually harmless, but they sit alongside one rule that never changes: any bleeding after menopause always needs a check.
What they are
Endometrial polyps are localised overgrowths of the womb lining (the endometrium), attached by a narrow stalk or a broader base and projecting into the hollow space inside the womb (the uterine cavity). They are made up of endometrial glands, supporting tissue and small blood vessels – essentially an outgrowth of the same lining that normally thickens and sheds with each menstrual cycle. Polyps can be single or multiple, and they range in size from just a few millimetres to several centimetres. A polyp on a long stalk can occasionally reach down towards the cervix.
The great majority are benign, and many never cause any trouble at all. But “usually harmless” is not the same as “always harmless”, and that distinction matters most after the menopause, when the lining should normally be thin and inactive. This is why a polyp discovered on a scan is usually looked at more closely rather than simply ignored.
How common they are
Polyps are common, and become more frequent with age – they are seen most often in women in their 40s and 50s, and around and after the menopause. Because so many produce no symptoms, they are frequently picked up by chance during a pelvic ultrasound or fertility assessment done for another reason. The great majority are benign; only a small proportion contain precancerous or cancerous change, and that risk is higher in women who have already gone through the menopause, especially if they are bleeding. It is more useful to think of this as a small but real possibility to be excluded, rather than a fixed percentage.
Symptoms
Many polyps cause no symptoms at all and are found incidentally. When they do cause problems, the commonest sign is abnormal bleeding, which can take several forms:
- Irregular or unpredictable periods, or bleeding at odd times in the cycle;
- Heavy periods (menorrhagia);
- Bleeding or spotting between periods;
- Bleeding after sex;
- And – most importantly – any bleeding after the menopause, even a single episode of light spotting.
Polyps are also sometimes linked to difficulty conceiving or to recurrent early miscarriage, thought to be because they can interfere with the lining where an embryo would implant. If you are having trouble conceiving, a gynaecologist may look for polyps as one of several possible factors. Polyps do not usually cause pain, so pelvic pain generally points to another cause.
Causes
The exact trigger is not fully understood, but polyp growth appears to be driven largely by the hormone oestrogen, which stimulates the womb lining. Situations that expose the lining to more oestrogen, or to oestrogen without the balancing effect of progesterone, tend to encourage the lining to overgrow in localised patches. Polyps are not caused by anything you have done wrong, they are not infectious, and they are not passed on to others.
Who is at risk
Polyps can occur in any woman with a womb, but several factors make them more likely:
- Being around or after the menopause, or in the perimenopausal years;
- Higher lifetime oestrogen exposure;
- Higher body weight, as fatty tissue produces additional oestrogen;
- High blood pressure (hypertension);
- Taking tamoxifen, a medicine used in breast cancer treatment, which acts on the womb lining and is associated with polyps and other lining changes.
Some of these factors – older age, higher body weight, tamoxifen use and bleeding after the menopause – are also the situations where doctors are a little more cautious, because they overlap with the risk factors for womb (endometrial) cancer. Having a risk factor does not mean a polyp is cancerous; it simply means assessment is worthwhile.
How it is diagnosed
Diagnosis usually starts with a conversation about your bleeding pattern and a pelvic examination, followed by imaging:
- Pelvic (transvaginal) ultrasound is normally the first test. It can show a thickened lining or suggest a polyp, and is widely available.
- Saline sonography (a “water” scan, also called sonohysterography) involves gently placing a little sterile fluid inside the womb during the ultrasound. The fluid separates the walls of the cavity so a polyp stands out more clearly.
- Hysteroscopy is the most definitive test. A thin camera is passed through the cervix to look directly inside the womb. It both confirms a polyp and, in the same session, usually allows it to be removed – and, importantly, lets the tissue be sent to the laboratory for examination.
In Singapore, a first assessment can begin with a GP or polyclinic, who can arrange an ultrasound or refer you to a gynaecologist; hysteroscopy is carried out by a gynaecologist. General health information is also available on HealthHub.
When it needs closer attention
Most polyps are benign. However, a small proportion can contain precancerous or cancerous change, and this is more likely after the menopause, particularly when there is bleeding. That is exactly why a polyp is not simply assumed to be harmless, and why removing it – so the tissue can be examined under a microscope – is often recommended rather than leaving it unchecked. The single most important message bears repeating: any bleeding after the menopause should always be checked by a doctor, because a benign polyp and a womb cancer can cause the very same symptom, and only assessment can tell them apart.
Treatment
Treatment depends on your symptoms, your age and whether you have gone through the menopause:
- Watchful waiting. Small, symptom-free polyps in women who have not reached the menopause and who have no risk factors may simply be monitored, as some polyps resolve on their own.
- Hysteroscopic removal (polypectomy). Polyps that cause symptoms, or those found in women after the menopause, are usually removed. This is done through a hysteroscope as a minimally invasive, often day-case procedure, and the removed tissue is sent for laboratory examination to confirm it is benign. Removal both relieves symptoms and provides a diagnosis.
The best approach is an individual decision made with your gynaecologist, who can weigh your symptoms, your risk factors and your own preferences. Because polyps can sometimes recur, any new abnormal bleeding after treatment should be reviewed again.
Living with it and after treatment
Most women who have a polyp removed recover quickly and find that abnormal bleeding settles. Light spotting or mild cramping for a short time after a hysteroscopic procedure is common; your care team will advise on what is normal for you and when you can return to usual activities. Because the removed tissue is examined, you should receive the results in due course, which is reassuring for most women.
Polyps can come back over time, so it is worth staying aware of your own bleeding pattern and mentioning any new changes at future reviews. Keeping to a healthy weight and having high blood pressure well controlled are sensible for overall health, and any hormone treatment – including hormone replacement therapy or tamoxifen – is best reviewed with the doctor who prescribes it rather than stopped on your own.
When to see a doctor
See a GP, polyclinic or gynaecologist if you notice irregular or heavy periods, bleeding between periods, or bleeding after sex – and always if you have any bleeding after the menopause, even once and even if it is only light spotting. These symptoms are often due to something benign such as a polyp, but they need to be checked so that womb cancer can be excluded. Seek urgent care – go to A&E or call 995 – if bleeding is very heavy (for example soaking through pads very quickly), or if you feel faint, dizzy or unwell with the bleeding.
Related women’s health topics
- Endometriosis
- Hysterectomy
- Pelvic organ prolapse
- Uterine (endometrial) cancer
- HPV vaccine
- Pre-eclampsia
- Breastfeeding problems
- Vulvodynia (vulval pain)
- Ovulation & fertility tracking
- Pap smear & cervical screening
- Menopause
- Gynaecologists in Singapore
Sources
- Cleveland Clinic — uterine (endometrial) polyps: definition, malignancy (~1 in 20), symptoms, risk factors, diagnosis, watchful waiting, treatment.
- StatPearls (NCBI) — endometrial polyp: symptoms, hysteroscopy as gold standard, histology especially postmenopause.
- Peer-reviewed studies — malignancy predictors in postmenopausal polyps (age, bleeding, BMI); recurrence after polypectomy.