Uterine polyps — properly called endometrial polyps — are soft, finger- or mushroom-shaped overgrowths of the lining of the womb. The overwhelming majority are benign. Most are found because a woman is being investigated for abnormal bleeding: heavier or erratic periods, spotting between periods, or any bleeding after menopause. The reason clinicians do not simply shrug at them is that the odds shift with context: a polyp that bleeds in a postmenopausal woman carries a meaningfully higher chance of containing pre-cancer or cancer than a silent polyp found by chance in a 42-year-old. That is why bleeding polyps after menopause are removed rather than watched.

What exactly is an endometrial polyp?

The endometrium is the lining that thickens and sheds each cycle. A polyp is a localised patch of that lining that keeps growing where it should have shed — a small knot of glands, connective tissue and blood vessels, attached to the uterine wall by a thin stalk or a broad base. They range from a few millimetres to several centimetres. You can have one or a dozen.

They are common, and they become more common with age up to around the time of menopause. Estimates put the prevalence somewhere between roughly 8% and 35% of women depending on age and how hard you look; many of those women never have a symptom in their lives.

Polyps are not fibroids. Fibroids are firm knots of muscle in the wall of the uterus; polyps are soft outgrowths of the lining, sitting in the cavity. They can coexist, and they can cause similar bleeding patterns — which is one reason imaging matters rather than guessing.

What are the symptoms of uterine polyps?

The honest answer is: often none. When they do cause symptoms, they are almost entirely bleeding symptoms.

  • Irregular or unpredictable periods — cycles that no longer keep to a pattern.
  • Heavier periods than your own normal, sometimes with clots (see heavy periods and period blood clots).
  • Spotting or bleeding between periods — the classic polyp signature (spotting between periods).
  • Bleeding or spotting after sex.
  • Any bleeding after menopause — even a single episode, even a pink smear on toilet paper.
  • Unexpected bleeding on HRT outside the expected pattern for your regimen — worth reporting to your prescriber rather than waiting it out.
  • Watery or blood-tinged discharge, particularly after menopause.
  • Difficulty conceiving, in women still trying — polyps can interfere with implantation.

Polyps rarely cause pain. Cramping suggests something else is also going on, or that a large polyp is being pushed toward the cervix.

A note that has to be said plainly: erratic, heavy bleeding in your forties is routinely waved away as "just perimenopause." Perimenopause genuinely does make cycles chaotic — see irregular periods in perimenopause. But "it's probably your hormones" is a conclusion, not an examination. If bleeding is heavy enough to disrupt your life, is soaking through protection, is leaving you exhausted (ask for a ferritin check — see iron deficiency anaemia), or is happening between periods, that deserves imaging, not reassurance.

How dangerous are uterine polyps? The honest number

Pooled evidence from systematic reviews of tens of thousands of removed polyps finds that roughly 3 in 100 contain either atypical hyperplasia (a pre-cancerous change) or endometrial cancer — a 2025 meta-analysis of 11,204 patients put malignancy alone at 2.75%. That means the great majority, around 97 in 100, are entirely benign. It is a low number — but it is not zero, and it is not evenly distributed. Two things move it: whether you have been through menopause, and whether the polyp is bleeding.

Approximate risk that an endometrial polyp contains pre-cancer or cancer, by context. Pooled estimates from systematic reviews; individual studies vary, so treat these as orders of magnitude, not precise odds.
Situation Approximate risk of pre-cancer or cancer What it usually means in practice
Premenopausal, no bleeding (found incidentally) Well under 2% — often quoted around 1% Watchful waiting is a reasonable option; small polyps can regress on their own
Premenopausal, with abnormal bleeding Roughly 2% Removal commonly offered — largely to stop the bleeding and get a diagnosis
Postmenopausal, no bleeding Roughly 2–3% Individualised decision; removal often advised, especially if large or you have risk factors
Postmenopausal, with bleeding Roughly 4–6%, higher in some series Removal and histology are standard — this is the group nobody watches and waits on

Two things raise the stakes further, independent of the polyp itself: tamoxifen (which strongly promotes polyp formation and is associated with higher-risk polyps) and factors that raise lifetime oestrogen exposure — obesity, PCOS, diabetes, and oestrogen-only therapy in a woman who still has a uterus. Hypertension and increasing age also appear in the risk models.

Set against all this is the harder fact that gets lost: the polyp is not the only thing being ruled out. Postmenopausal bleeding is the cardinal symptom of endometrial cancer. In a meta-analysis of 129 studies, about 90% of women with endometrial cancer had reported postmenopausal bleeding — and among women investigated for postmenopausal bleeding, around 9% (roughly 1 in 10) turned out to have endometrial cancer. Most causes of postmenopausal bleeding are benign — a thin fragile lining, a polyp, an HRT effect — but benign is a conclusion the tests reach, never an assumption the clinician starts with. Finding a polyp explains the bleeding; it does not, on its own, prove the bleeding is harmless. That is what the histology after removal is for.

One more thing that trips women up: there is no screening test for endometrial cancer in the general population, and a cervical smear (Pap test) does not detect it. A normal, recent smear tells you nothing about the lining of your womb. Reporting the symptom is the early-detection system — which is exactly why a single episode of bleeding after menopause earns a scan rather than a wait-and-see.

How are uterine polyps diagnosed?

The workup usually runs in this order, though not everyone needs every step.

  1. Transvaginal ultrasound (TVUS). The first-line scan. It measures the endometrial thickness and can show a focal thickening or a feeding vessel that suggests a polyp. In postmenopausal women with bleeding, a very thin lining (4 mm or less) makes cancer very unlikely — but a thin stripe does not close the question if the bleeding persists or comes back, and ultrasound is at its weakest at spotting small focal lesions like polyps. ACOG's guidance is explicit that recurrent or persistent bleeding requires further evaluation whatever the measurement showed. Say that out loud to your clinician if you are being discharged on the strength of a reassuring scan while you are still bleeding.
  2. Saline infusion sonohysterography (SIS, or saline sonogram). A little sterile saline is instilled into the cavity through a thin catheter, which separates the walls and outlines a polyp in silhouette. Far more sensitive than plain ultrasound for focal lesions, and done in clinic in a few minutes. Cramping is common for a short period; taking a simple painkiller beforehand is worth asking about.
  3. Hysteroscopy. The reference standard: a very narrow camera passed through the cervix so the polyp can be seen directly — and, increasingly, removed in the same visit ("see and treat"). Often done awake in an outpatient clinic; general or regional anaesthesia is an option, and you are allowed to ask for it.
  4. Endometrial biopsy (Pipelle). A thin suction sampler. It is good at picking up diffuse disease across the lining, but it samples blindly and can miss a focal polyp entirely. A "normal" blind biopsy in a woman who is still bleeding is not the end of the road — it is a reason to ask for hysteroscopy.

How are polyps removed, and what is recovery actually like?

The standard treatment is hysteroscopic polypectomy: the polyp is visualised through the hysteroscope and taken out with fine instruments, a tissue-shaving device, or an electrosurgical loop, then sent to the lab. It is a day procedure — no incisions, no overnight stay in the ordinary case. Simple blind curettage (scraping without a camera) is now considered inferior, because it frequently misses the polyp it is meant to remove.

What to expect, realistically:

  • The procedure itself commonly takes 10–30 minutes. Outpatient hysteroscopy without anaesthesia can hurt — for some women it is a mild period-type cramp, for others it is genuinely painful. This has been under-acknowledged for years, and NHS guidance now tells women to ask about pain relief in advance and to say if they want the procedure stopped. You can stop it.
  • Cramping like a period for a day or two afterwards, usually manageable with over-the-counter painkillers.
  • Light bleeding or watery, blood-tinged discharge for a few days up to a couple of weeks.
  • Back to normal activity within a day or two after an outpatient procedure; a few days if you had a general anaesthetic. Many women drive themselves home after outpatient hysteroscopy but not after sedation.
  • Sex, tampons, swimming — most units advise waiting until the bleeding stops (often about a week), largely to reduce infection risk. Follow your own unit's instructions.
  • Results from the lab usually take one to two weeks. Ask specifically how you will be told, and chase it if you hear nothing.

Serious complications are uncommon — uterine perforation occurs in well under 1% of diagnostic procedures, and infection or heavy bleeding are rare. But you should be told what to watch for (below).

Removal reliably improves bleeding for most women whose bleeding was caused by the polyp. If your bleeding does not settle afterwards, that is information: it suggests the polyp was not the whole story, and it warrants a return visit rather than acceptance.

Can uterine polyps come back?

Yes. Recurrence after hysteroscopic removal is reported in something like 2–15% of women in most series, and higher — up to a third or more in some studies — in women who had multiple polyps to begin with, or who are on tamoxifen. Recurrence is not a sign the surgery failed; the endometrium simply retains the tendency. If bleeding returns, the polyp question reopens from the start, including the histology question: a new polyp needs its own diagnosis, not an assumption based on the last one.

Women on tamoxifen, and women taking oestrogen who have a uterus, are usually monitored more closely, and a progestogen-containing intrauterine system is sometimes used to protect the lining. Any of those decisions belong to your prescriber — do not start, stop or adjust hormone treatment on your own.

When to see a doctor

Get medical assessment — do not wait, do not self-monitor — if you have any of the following.

  • Any vaginal bleeding after menopause (defined as 12 months with no period), however small, however brief, whether or not you are on HRT. One spot counts. Bleeding after menopause is never "just one of those things": in England, NICE tells GPs to refer women aged 55 and over with unexplained postmenopausal bleeding on the urgent suspected-cancer pathway — appointment within two weeks — and to consider the same referral under 55. If you are on HRT and bleeding unexpectedly, tell your prescriber rather than deciding for yourself that the HRT explains it.
  • Watery, pink or blood-stained discharge after menopause, even with no frank bleeding. New watery or blood-tinged discharge after menopause can be the presenting sign of endometrial cancer; it is assessed, not watched.
  • Bleeding after menopause that continues or recurs, even after a reassuring scan or a normal biopsy. A thin endometrial stripe lowers the probability of cancer; it does not close the case while the bleeding is still happening, and a blind biopsy can miss a focal lesion. Ask to be re-evaluated, and ask specifically about hysteroscopy.
  • Bleeding between periods, after sex, or periods that have become distinctly heavier or more chaotic than your normal in your forties — worth investigating, not filing under "perimenopause."
  • Heavy bleeding with breathlessness, dizziness, palpitations or exhaustion — ask for a full blood count and ferritin.
  • After a hysteroscopy or polypectomy: fever, foul-smelling discharge, severe or worsening pain, or bleeding heavier than a normal period (soaking a pad an hour) — contact the unit that treated you, urgently.

If you are premenopausal and your discharge is white, clear, brown at the tail end of a period, or pink around ovulation, that is usually normal physiology — see vaginal discharge. The rules are different before and after menopause, and that difference is the single most important thing on this page.

Questions worth asking at the appointment

  • What is my endometrial thickness on the scan, and what does it mean given my menopausal status?
  • Has a focal lesion been excluded, or only a thick lining? Do I need a saline sonogram or hysteroscopy?
  • If I am still bleeding, what is the plan if these results come back normal?
  • Will the polyp be sent for histology, and how will I be told the result?
  • What pain relief options do I have for outpatient hysteroscopy, and can I stop the procedure if I need to?

Bringing a written bleeding record helps enormously — dates, heaviness, what you were doing. The period tracker can generate one, and the doctor report tool can turn your symptom history into something you can hand across the desk. More on the wider picture in our gynecologic health guide.

This article is for information, not medical advice. It does not diagnose, and nothing here should be used to start, stop or change any medication or hormone therapy — that is a conversation with your prescriber.