Endometrial polyps: symptoms, how they are found and how they are treated

The endometrium is the lining of the womb. The RCOG explains that a polyp inside the uterus is a skin tag that looks like a small grape, sometimes on a stalk, and that polyps are caused by an overgrowth of the lining of the womb. The NHS lists fibroids or small growths (polyps) among the problems that hysteroscopy can help to diagnose or treat.

Polyps are different from fibroids, which the RCOG describes as knots in the muscle of the womb that are non-cancerous. Fibroids can sometimes bulge like a polyp into the lining and may be removed for the same reason, but they are a separate condition.

The sources used for this page describe the situations in which polyps are looked for rather than a fixed list of polyp symptoms. The RCOG lists reasons for referral for an outpatient hysteroscopy that include bleeding after the menopause, heavy or prolonged periods, bleeding between periods, irregular bleeding while on hormonal treatment, something seen on an ultrasound scan such as an endometrial polyp or fibroid, and fertility concerns following a miscarriage. The NHS lists very heavy periods or bleeding between periods, bleeding after the menopause, problems getting pregnant or repeated miscarriages as reasons for hysteroscopy.

The NHS says that changes in your periods may not mean there is a problem but need to be investigated. It also says that bleeding between periods, after sex or after the menopause needs to be checked by a doctor, because it might be caused by an infection, abnormalities in the cervix or, in rare cases, cancer. Many polyps cause no symptoms and are found by chance on a scan done for another reason.

A GP will ask about your symptoms and periods and may arrange tests. A pelvic ultrasound scan may show a thickened lining or a possible polyp. Because an ultrasound picture is not always conclusive, the usual next step is a hysteroscopy, which lets the doctor see the inside of the womb directly.

The NHS describes a hysteroscopy as a test to look inside the womb using a thin tube with a small camera inside it. The tube is inserted into the vagina, passed through the cervix and into the womb, and salt water (saline solution) is injected through the tube to make it easier to see. The camera sends images to a screen, and you can watch the screen if you want to.

The RCOG says an outpatient hysteroscopy can be accompanied by an endometrial biopsy, in which a sample is taken from the lining of the womb, and that polyp removal can sometimes be done in the same visit.

The NHS says that sometimes a sample of tissue (biopsy) is taken during a hysteroscopy, or fibroids and polyps are removed. The RCOG lists polyp removal as an additional procedure that may be possible during the same visit, and says that you can choose to have your hysteroscopy with an anaesthetic or with sedation in an operating theatre, usually as a day case.

Removal gives both treatment and, because the tissue can be examined in a laboratory, information about what the polyp is. Your clinician will explain whether any removed tissue is being sent for testing and how you will be told the result.

The NHS says hysteroscopy can be uncomfortable and may feel like period pain, and that taking ibuprofen or paracetamol 1 hour before can help. For many people it can be very painful, so if you are worried about pain you should speak to staff beforehand. It may be possible to have a general anaesthetic or intravenous sedation, though not all hospitals offer this. You may feel sick or faint during the procedure, and you can ask to stop at any time.

The RCOG says possible risks of outpatient hysteroscopy include severe pain, feeling faint or sick, bleeding, infection and rarely damage to the wall of the uterus, and that sometimes it is not possible to complete the procedure in an outpatient clinic. The NHS says infection can be treated with antibiotics and that there is a rare risk of making a small hole in the wall of the womb when removing a polyp, which can sometimes need an overnight stay or, occasionally, an operation to repair.

The NHS says it is normal to have pain similar to period pain for a couple of days afterwards, and some bleeding or spotting for up to a week. Use pads, not tampons, and avoid exercise and sex until pain and bleeding have stopped.

The NHS says to contact the hospital or clinic urgently if you have bleeding that gets worse or does not stop after a few days, tummy pain that gets worse and is not helped by painkillers, a high temperature or smelly vaginal discharge. You can also call 111.

On the NHS, a GP or hospital doctor can refer you for a hysteroscopy if they think you need one, and the NHS says you will be given printed information about the procedure beforehand. Waiting times vary by area and by how urgent the referral is.

Private gynaecology clinics also offer scans and hysteroscopy, sometimes with shorter waits. In both settings, ask what pain relief is offered and whether any polyp found can be removed during the same visit.