Endometrial (uterine) polyps: Symptoms, treatment, and removal

What are endometrial polyps (uterine polyps)?

Endometrial polyps are finger-like growths attached to the inner lining of the uterus (the endometrium). These range in size from a few millimetres to being larger than a golf ball. Endometrial polyps are usually benign, although some are cancerous or become so in time.

How fast do endometrial polyps grow?

The growth rate of endometrial polyps varies from person to person. Factors such as hormone levels, particularly oestrogen, can speed up their growth. In some women, endometrial polyps go away spontaneously.

Other uterine conditions not to be confused with polyps

Uterine polyps vs uterine fibroids

• Uterine polyps are growths made of the tissue lining the uterus (endometrial tissue), while fibroids develop from the muscle tissue inside the walls of the uterus.
• While uterine polyps and fibroids often share symptoms such as heavy menstrual bleeding and fertility problems, fibroids may also bring additional issues, including frequent urination, constipation, and lower back pain, which are not typical of polyps.
• While both are usually benign, polyps have a higher likelihood of being linked to cancer compared to fibroids.

Endometrial polyps vs endometriosis

• Endometrial polyps are overgrowths of the endometrial tissue. These growths are attached to the inner wall of the uterus. Endometriosis is a condition where tissue similar to the endometrium (the inner lining of the uterus) grows outside the uterus, such as on the ovaries, fallopian tubes, and other parts of the body.

Why do endometrial polyps form?

The exact cause of endometrial polyps is not fully understood, but high levels of oestrogen as well as inflammation appear to be contributing factors. Other risk factors are discussed below.

Causes and risk factors

Key factors that may increase the risk of developing endometrial polyps include:

• Being overweight (BMI 25 – 29.9) or obese (BMI > 30)
• Use of tamoxifen, an antioestrogen drug for treating or preventing breast cancer. While tamoxifen blocks the effects of oestrogen in breast tissue, it can have the opposite effect on the uterus, promoting endometrial cell proliferation.

• Age: Endometrial polyps can affect women of all ages, but they are most commonly diagnosed in women who are in their 40s and 50s. They are rare in women under 20. 
• Having hypertension or high blood pressure 
• Taking hormone replacement therapy.

Uterine polyps symptoms

While some women may experience no symptoms at all, others may notice changes in their menstrual cycle or overall gynaecological health, such as: 

• Abnormal vaginal bleeding, which can manifest as spotting or heavier bleeding after intercourse, outside of the normal menstrual cycle, or even after menopause. 
• Irregular periods, such as variations in the timing, duration, and heaviness of periods
• Heavy menstrual bleeding (menorrhagia)
• Infertility

If you’re experiencing any of these symptoms, it’s important to consult a healthcare professional for a thorough evaluation. 

Possible complications

While uterine polyps are usually benign, some can be cancerous or precancerous, with the risk being higher in postmenopausal women.

Uterine polyps can also create fertility issues, making it difficult for you to become pregnant or increasing the risk of a miscarriage. Removing the polyps may help solve fertility problems, but data on this is inconclusive.

How do you diagnose endometrial polyps?

Diagnosing endometrial polyps in the uterus involves a variety of tests and procedures, and may include: 

• Transvaginal ultrasound: a wand-like device (transducer) that emits sound waves is inserted in the vagina to create images of the uterus
• Sonohysterography: sterile saline is injected into the uterus to expand the cavity, providing a clearer view of the uterine cavity
• Hysteroscopy: a thin, lighted telescope (hysteroscope) is inserted into the vagina and cervix to allow for the examination of the inside of your uterus and removal of polyps if needed
• Endometrial biopsy: a small tissue sample is taken from the uterine lining to check for abnormal or cancerous cells
• Curettage (D&C): a long metal instrument (curette) is used to collect tissue from the uterus or to remove polyps.

Certain health insurance plans may cover the cost of these procedures when done privately. Talk to your broker or insurer to know if this is included in your policy. 

Uterine polyps treatment

Treatment depends on factors like your age, the size of the polyps, the severity of symptoms, and whether there’s a risk of malignancy. Not all polyps need active treatment, and several approaches are available. 

• Watchful waiting: If a polyp is small and not causing any symptoms, your doctor may simply monitor it. In some cases, these polyps go away on their own. However, if you are post-menopausal or at higher risk of uterine cancer, removal is usually recommended instead of waiting.
• Medications: Hormonal medications such as progestins or gonadotropin-releasing hormone agonists may be prescribed to help reduce symptoms like heavy bleeding. These medications can be effective in the short term, but symptoms often return once you stop taking them.
• Surgical removal: Polyps can be removed during hysteroscopy (hysteroscopic polypectomy), and the removed tissue is sent to a laboratory to check for cancer cells. If cancer is detected, further surgery such as a hysterectomy (removal of the uterus) may be needed. Many women experience significant improvement in symptoms after polyps are removed.

Will uterine polyps come back after treatment?

Uterine polyps may recur after treatment. Regular monitoring and follow-up care are important to detect and manage any new growths.

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Health insurance and pre-existing conditions

How can insurance help?

Dealing with endometrial polyps can be stressful, especially when you’re confronted with long waits in the public health system and the costs of diagnostic tests and surgeries if you go private. 

• Having a good health insurance plan helps speed up treatment and cover your private medical expenses, so you can get the care you need. Some policies may have specific terms and conditions for covering the removal of uterine polyps; ask your broker or insurer, or refer to the relevant policy document for further info.

• If you’re diagnosed with a serious illness such as cancer, critical illness insurance may provide a lump sum payment. You can use this benefit to cover medical expenses, replace lost income, and stay on top of your bills during treatment and recovery.
• If you need an extended period off work for major treatment procedures and recovery, income cover or mortgage protection insurance may help replace lost earnings. These plans ensure you can focus on your health without worrying about paying your rent or mortgage, and other bills.

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