Endometrial Polyps: Symptoms, Diagnosis and When Removal Is Needed

In short

An endometrial polyp is a soft growth of the lining inside the womb. Most polyps are benign. They can cause irregular or heavy bleeding, bleeding after menopause, or difficulty conceiving, and many cause no symptoms at all. A transvaginal scan usually finds them, and hysteroscopy confirms and removes them in the same sitting, through the natural passage, without any cut on the abdomen. Not every polyp needs removal; the decision depends on your symptoms, your age, whether you have reached menopause, and your plans for pregnancy.

What is an endometrial polyp?

The inside of the womb is lined by the endometrium, the layer that thickens and sheds each month. A polyp is a small, localised overgrowth of this lining, attached to the wall of the womb by a broad base or a thin stalk. Polyps range from a few millimetres to a few centimetres, and there may be one or several.

They are common, and they become more common with age. Women taking tamoxifen (a breast-cancer medicine) and women being evaluated for infertility are also more likely to have them.

Symptoms: what women usually notice

• Bleeding or spotting between periods, or after intercourse
• Periods that are heavier or longer than before (see our guide to heavy menstrual bleeding)
• Any bleeding after menopause, even a single episode of spotting
• Difficulty conceiving, when a polyp is found during fertility tests

Many polyps cause no symptoms and are found on a routine scan. Finding one does not, by itself, mean something is wrong.

How polyps are diagnosed

Transvaginal ultrasound is usually the first test. It is most informative soon after a period ends, when the lining is thin and a polyp stands out. If the picture is unclear, saline sonography outlines the cavity more clearly.

Hysteroscopy is the most accurate test: a thin telescope passed through the cervix lets the surgeon see the inside of the womb directly. Its advantage is that a polyp seen can usually be removed in the same procedure, and the tissue sent for examination.

Is a polyp cancer?

Almost always, no. Most polyps are benign. The chance of abnormal cells within a polyp is higher after menopause and when there is bleeding. In a review of 17 studies, about 5 in 100 polyps removed after menopause showed precancerous or cancerous change, compared with fewer than 2 in 100 in women of reproductive age (Lee 2010).

This is why bleeding after menopause should always be checked, and why a polyp in that situation is removed and examined rather than watched.

Does every polyp need to be removed?

No. International guidance (AAGL 2012) notes that up to a quarter of polyps, particularly those smaller than 10 mm, can shrink or disappear on their own. A small polyp found by chance in a woman without symptoms, who is not trying to conceive and has not reached menopause, can often be watched with a repeat scan.

Removal is usually advised when:

• the polyp is causing bleeding symptoms
• you have reached menopause, especially if there has been any bleeding
• you are trying to conceive, or preparing for IUI or IVF
• the polyp is large or growing, or you are taking tamoxifen

Your doctor will weigh these with you. The aim is to treat what needs treatment, and not to operate on what does not.

Polyps and fertility

A polyp can interfere with implantation of an embryo. In a randomised trial of women with polyps who were about to start intrauterine insemination, those whose polyps were removed by hysteroscopy were about twice as likely to become pregnant as those whose polyps were left in place (Pérez-Medina 2005). Many of those pregnancies occurred even before the first insemination.

For this reason, when a polyp is found during a fertility work-up, removal before IUI or IVF is usually recommended.

Hysteroscopic polypectomy: what to expect

• Route: through the vagina and cervix, under direct vision. There is no cut on the abdomen.
• Anaesthesia: as advised by the anaesthetist, usually short.
• Duration and stay: the procedure is usually brief, and most women go home the same day.
• Afterwards: light spotting and mild cramps for a few days are common. Most women return to routine activity within a day or two.
• Results: the removed tissue is examined in the laboratory, and your doctor will go through the report with you.

Guidance advises that polyps be removed under direct vision rather than by blind curettage, which can miss them. You can read more about the procedure on our hysteroscopy page.

Can polyps come back?

Yes, a new polyp can form in time, especially in women prone to them. If symptoms return, a scan is the simple first step. Your doctor will tell you whether any follow-up scan is needed in your situation.

When to see a gynaecologist

See a doctor if you have bleeding between periods or after intercourse, periods that have become heavier, any bleeding after menopause, or if you have been trying to conceive for a year (six months if you are over 35). Bring any earlier scan reports with you. Book a consultation.

Frequently asked questions

Is an endometrial polyp dangerous?
Most polyps are benign. The chance of abnormal cells is higher after menopause and when there is bleeding, which is why those polyps are removed and examined.

Can a polyp go away without treatment?
Some can. Up to a quarter of polyps, especially those smaller than 10 mm, may shrink or disappear on their own, so a small polyp without symptoms can often be watched with a repeat scan.

Do polyps stop you getting pregnant?
They can make implantation less likely. In a randomised trial, removing polyps before IUI roughly doubled the chance of pregnancy, so removal is usually advised for women trying to conceive.

How is a polyp removed?
By hysteroscopy, through the cervix under direct vision, with no cut on the abdomen. Most women go home the same day and resume routine activity within a day or two.

Can a polyp come back after removal?
A new polyp can form over time. If symptoms return, a scan is the first step, and your doctor will advise whether any follow-up is needed.

Sources and further reading

• AAGL. Practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19(1):3–10. doi:10.1016/j.jmig.2011.09.003
• Lee SC, Kaunitz AM, Sanchez-Ramos L, Rhatigan RM. The oncogenic potential of endometrial polyps: a systematic review and meta-analysis. Obstet Gynecol. 2010;116(5):1197–205. doi:10.1097/AOG.0b013e3181f74864
• Pérez-Medina T, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod. 2005;20(6):1632–5. doi:10.1093/humrep/deh822

General education, not personal medical advice. Last reviewed: October 2026.