What is a uterine polyp?

Uterine polyps, also known as endometrial polyps, are noncancerous growths that develop from the endometrium—the inner lining of the uterus. They arise when endometrial glands and stroma proliferate abnormally, forming localized, often pedunculated (stalk-like) or sessile (broad-based) lesions. While most uterine polyps are benign, a small percentage—particularly in postmenopausal individuals or those with risk factors such as obesity, hypertension, or tamoxifen use—may harbor atypical hyperplasia or, rarely, endometrial carcinoma.

Symptoms vary widely: many polyps are asymptomatic and discovered incidentally during imaging or evaluation for unrelated concerns. When present, common manifestations include abnormal uterine bleeding—such as intermenstrual spotting, menorrhagia (heavy menstrual bleeding), prolonged periods, or postmenopausal bleeding. Polyps may also contribute to infertility or recurrent pregnancy loss by interfering with embryo implantation or disrupting the uterine cavity’s architecture.

Diagnosis typically begins with transvaginal ultrasound, which may reveal focal endometrial thickening or a well-defined intrauterine mass. Saline infusion sonohysterography (SIS) enhances detection sensitivity, while hysteroscopy remains the gold standard for both definitive diagnosis and therapeutic intervention. During hysteroscopy, the polyp can be directly visualized and excised under direct visualization.

Management depends on symptom burden, reproductive goals, and patient characteristics. Asymptomatic polyps in premenopausal patients may be monitored conservatively, especially if small (<1 cm) and incidental. Symptomatic, large, or postmenopausal polyps generally warrant hysteroscopic polypectomy. Histopathologic examination of the resected tissue is essential to rule out malignancy or premalignant changes. Recurrence is possible, particularly in patients with underlying hormonal imbalances or chronic endometritis, so follow-up and individualized counseling are key components of care.