Endometrial Polyps

Dr. Wei-Wei Wee-Stekly

Senior Consultant Obstetrician & Gynaecologist

MBBS (London), MRCOG (United Kingdom), MMed (O&G) (Singapore), FAMS (Singapore), FRCOG (United Kingdom)

Endometrial polyps are a common cause of irregular bleeding in women, particularly during midlife and perimenopause. While they can sound concerning, most endometrial polyps are benign (non-cancerous) and easily treatable once identified.

Many women discover they have a polyp only after investigating symptoms such as spotting between periods or after menopause. Others may not have any symptoms at all and find out during a routine pelvic ultrasound or fertility evaluation. Regardless of how they’re discovered, polyps are generally manageable with minimally invasive treatment.

What are Endometrial Polyps?

Endometrial polyps are soft, finger-like growths that form on the inner lining of the uterus (the endometrium). They are made up of endometrial tissue and can vary in size — from a few millimetres to several centimetres.

Polyps may appear alone or in multiples. They can be attached to the uterine lining by a thin stalk or sit flat against the wall. Though they are usually benign, in rare cases, they may contain precancerous or cancerous cells, particularly in postmenopausal women.

Polyps are more common in women between 40 and 50 years old, but they can occur at any age, including in younger women dealing with fertility issues or hormonal imbalances.

What Are the Symptoms of Endometrial Polyps?

Not all polyps cause symptoms. In many cases, they’re found incidentally during imaging or procedures for other concerns. However, when symptoms do occur, they may include:

• Irregular or unpredictable menstrual bleeding
• Spotting between periods
• Heavy menstrual flow
• Bleeding after sexual intercourse
• Bleeding after menopause
• Infertility or difficulty conceiving

Because these symptoms overlap with other gynaecological conditions (like fibroids or endometrial hyperplasia), proper evaluation is essential for accurate diagnosis.

What Causes Endometrial Polyps?

The exact cause of endometrial polyps isn’t fully known, but several factors are believed to contribute:

• Hormonal imbalances, particularly high levels of oestrogen
• Perimenopause and menopause-related changes
• Obesity
• High blood pressure
• Hormone replacement therapy (HRT)

Women with polyps often have an oestrogen-dominant environment in the uterus, which may stimulate excessive growth of the endometrial lining.

How Are Endometrial Polyps Diagnosed?

If your doctor suspects a polyp based on symptoms or irregular bleeding, several diagnostic tools may be used:

• Transvaginal ultrasound – A common first step to visualise the uterus and detect thickening or growths.
• Saline infusion sonohysterography (SIS) – A small amount of fluid is introduced into the uterus during ultrasound to provide clearer imaging of the endometrial cavity.
• Hysteroscopy – A thin camera is inserted into the uterus to directly visualise and sometimes remove the polyp at the same time.
• Endometrial biopsy – A sample of the uterine lining may be taken to check for abnormal or precancerous cells, especially in postmenopausal women or those with risk factors.

Getting an accurate diagnosis allows your doctor to determine the most appropriate treatment plan.

When Should You See a Gynaecologist?

You should consult a gynaecologist if you experience:

• Irregular or heavy bleeding
• Spotting between periods
• Bleeding after menopause
• Difficulty getting pregnant
• An abnormal ultrasound finding or Pap smear

Early diagnosis and treatment of polyps can prevent complications and provide relief from disruptive symptoms.

How Are Endometrial Polyps Treated?

Treatment depends on your age, symptoms, and risk factors. In some cases, especially when polyps are small and symptom-free, watchful waiting may be advised. However, in most cases, removal is recommended, particularly if:

• You have abnormal bleeding
• You are postmenopausal
• You are trying to conceive
• The polyp appears large or irregular

The most common and effective treatment is hysteroscopic polypectomy , a minimally invasive procedure in which a small scope is inserted through the cervix and the polyp is removed under direct visual guidance. This procedure is typically done on an outpatient basis and has a short recovery time.

If a polyp is found to be precancerous or cancerous, further evaluation and treatment may be necessary depending on the findings.

Can Endometrial Polyps Affect Fertility?

Yes, they can. Endometrial polyps may interfere with embryo implantation, increase the risk of miscarriage, or cause cycle irregularities that affect timing of ovulation. For women undergoing fertility treatments such as IUI or IVF, polyp removal is often recommended to improve the chances of success.

After removal, many women experience improved menstrual regularity and higher chances of conception, especially if polyps were contributing to unexplained infertility.