Understanding endometrial polyps
Endometrial polyps are a common gynaecological condition that can affect women of any age, but are most frequently seen in those in their 40s and 50s. While they are usually benign (non-cancerous), they can cause troublesome symptoms and occasionally lead to more serious concerns. This article by a consultant gynaecologist, Dr Elizabeth Egbase, outlines what endometrial polyps are, what causes them, how they are diagnosed and treated, and when further investigation may be needed.
What are endometrial polyps?
Endometrial polyps are growths of tissue that develop on the inner lining of the uterus, known as the endometrium. These growths can vary in size—from just a few millimetres to several centimetres—and may appear as single or multiple polyps. They are often attached to the uterine wall by a stalk and can sometimes protrude into the cervical canal or even the vagina.
Most endometrial polyps are non-cancerous, but in some cases, especially after menopause, they can be associated with abnormal or pre-cancerous changes. For this reason, any symptoms or changes in bleeding should be discussed with a GP or gynaecologist.
What causes endometrial polyps?
The exact cause of endometrial polyps isn’t always clear, but they are believed to be linked to hormonal imbalances, particularly involving oestrogen. Oestrogen stimulates the growth of the endometrium, and an excess can lead to the development of polyps. They are more commonly found in women who are:
- Perimenopausal or postmenopausal
- Taking hormone replacement therapy (HRT) or tamoxifen (a breast cancer medication)
- Overweight or obese
- Living with conditions such as polycystic ovary syndrome (PCOS) or hypertension
There may also be a genetic or familial component in some cases, although this is less well established.
Symptoms of endometrial polyps
Many women with endometrial polyps have no symptoms at all, and the polyps are found incidentally during a scan or investigation for another reason. However, when symptoms do occur, they can include:
- Irregular or heavy periods
- Bleeding between periods
- Postmenopausal bleeding
- Infertility or difficulty conceiving
- Pelvic discomfort, especially if the polyp is large or prolapsing
Any postmenopausal should always be evaluated promptly, even if it seems mild or happens only once.
Do endometrial polyps need to be treated?
Whether or not a polyp needs treatment depends on several factors, including size, symptoms, and the patient's age or menopausal status. Small, symptomless polyps may not require immediate treatment and can be monitored. However, treatment is usually recommended if:
- The polyp is causing symptoms
- It is large or growing
- The woman is postmenopausal
- There is any suspicion of abnormal cells
Possible complications of untreated polyps include ongoing bleeding, anaemia due to blood loss, and in rare cases, interference with fertility. In women undergoing fertility treatment, polyp removal may improve the chances of implantation.
Are endometrial polyps at risk of developing into cancer?
While most endometrial polyps are benign, there is a small risk that they may contain pre-cancerous or cancerous cells, particularly in postmenopausal women or those with risk factors such as obesity, diabetes, or a history of breast cancer. Because of this, polyps are usually sent for histological examination after removal to rule out malignancy. The risk of cancer is low overall, but the importance of proper assessment and follow-up should not be underestimated.
How are endometrial polyps removed?
Endometrial polyps are typically removed using a procedure called hysteroscopy. This is a minimally invasive technique where a thin camera (the hysteroscope) is inserted through the cervix into the womb to visualise the polyp. Special instruments can then be used to remove the polyp at the same time.
Hysteroscopy is usually done as a day-case procedure, either under local or general anaesthesia. Recovery is generally quick, with most women able to return to normal activities within a day or two. Mild cramping or spotting may occur for a short period afterwards.
If a polyp is too large or if there are multiple growths, additional procedures such as dilation and curettage may be used. The removed tissue is always sent to the lab for analysis.