If you’re approaching menopause and experience vaginal bleeding outside of your normal pattern, it could be due to a condition called uterine polyps. The good news is if your polyps become problematic, they are treatable. Here’s what you need to know.
Top things to know:
- Uterine polyps are abnormal growths on the inside lining the uterus
- They occur most commonly leading up to and after menopause
- Symptoms include irregular bleeding between periods and periods that vary in length and heaviness
Smaller polyps are often not noticeable, or can go away on their own, but problematic polyps can be treated with medications, non-invasive surgery, and/or lifestyle changes.
What they are
Uterine polyps are abnormal growths on the inside lining the uterus (the endometrium). They are sometimes called endometrial polyps and can cause symptoms such as irregular vaginal bleeding (1, 2).
Uterine polyps are very common. Up to 3 in 10 people may have them at some point in their lives (3, 4), but fewer than 1 in 100 people develop polyps before age 30 (3, 5). They occur most commonly leading up to and after menopause (6). Small polyps may cause no symptoms at all and can go away on their own (2, 7). In other cases, untreated polyps may cause symptoms that affect quality of life and can carry a small chance of becoming cancerous (3, 8). They may also affect fertility, but research on this topic is still lacking (9, 10).
Nearly all symptoms of uterine polyps are easy to track. Tracking your bleeding patterns, pain, other symptoms with Clue can provide your healthcare provider with information that may help with diagnosis and in forming a treatment plan. Early treatment can reduce the risk of complications.
What you might notice
Signs and symptoms of uterine polyps include:
- Irregular bleeding between periods or after menopause
- Periods that vary in length and heaviness
- Very heavy periods
- Difficulty getting pregnant (1, 2, 8–12)
Why they happen
Uterine polyps occur when cells of the uterine lining (the endometrium) multiply too many times. As this happens, lumps are formed. These lumps often resemble hanging sacs or mushrooms made of tissue (14). Most are very small, but can range in size from a few millimeters, to several centimeters in diameter (15). Polyps can be numerous or few, and some people might only have one. Some research shows that estrogen plays an important role in the formation of polyps, but it’s not yet clear how (4).
Some people are more likely than others to develop uterine polyps. They are most common in people who are perimenopausal and postmenopausal. People who have obesity are also significantly more likely to develop polyps (4, 16, 17). Another contributing factor may be taking the breast cancer drug tamoxifen (18, 19).
Uterine polyps are similar to one type of uterine fibroids. Fibroids form from muscle tissue in the uterus, but can cause many of the same symptoms, as well as other ones. The biggest difference is that fibroids are more likely to be problematic in the reproductive years and shrink after menopause, while polyps are more likely to be problematic after menopause.
Why get them checked out?
Small uterine polyps are often asymptomatic, and can come and go on their own (2, 7). Some untreated polyps, however, may cause symptoms that affect quality of life and can lead to complications such as anemia (20). Anemia is a condition when the body doesn’t have enough healthy red blood cells to function properly. This can happen when uterine polyps cause a high amount of blood loss (21).
In rare cases, some uterine polyps carry a small chance of becoming cancerous (3, 8). They may also affect the ability to get or stay pregnant, but research on this topic is still lacking (9, 10).
How they’re diagnosed
A healthcare provider will probably ask questions about symptoms and medical and menstrual history and perform a simple physical exam. If they suspect you have uterine polyps, they may also perform:
- A transvaginal ultrasound
- A hysteroscopy: a small camera inserted into the uterus
- A biopsy: a small tool is inserted into the uterus to take a tissue sample
What you can do about them
Small uterine polyps can go away on their own without treatment (2, 7). If they do become problematic, there are a few different options treating existing polyps, and for preventing their future formation.
- Medications: Hormonal medications are sometimes prescribed to treat the symptoms of uterine polyps. These include Gonadotropin Releasing Hormone (GnRH) agonists, which block the body’s production of certain hormones progesterone, and progesterone, often prescribed in the form of a cream. These has been little research on the effectiveness of these hormonal treatments for uterine polyps (22).
- Non-invasive surgery: Small polyps can be removed with a process called hysteroscopic excision. About 7 in 10 people with small polyps (<1cm) found their symptoms significantly improved after this procedure (1, 2, 11)
- Lifestyle Changes: In people who suffer from uterine polyps and obesity, weight loss may improve their prognosis, but research on this is still unclear (16, 23)
What to track
Essential to track
- bleeding patterns
- pain
Helpful to to track
- heaviness of bleeding
- sex (if trying to get pregnant)
References
1. Clark, T. J., Middleton, L. J., Am Cooper, N., Diwakar, L., Denny, E., Smith, P., … & Bingham, T. (2015). A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding. Health Technology Assessment (Winchester, England), 19(61), 1.
2. Hamani, Y., Eldar, I., Sela, H. Y., Voss, E., & Haimov-Kochman, R. (2013). The clinical significance of small endometrial polyps. European Journal of Obstetrics & Gynecology and Reproductive Biology, 170(2), 497–500.
3. Anastasiadis, P. G., Koutlaki, N. G., Skaphida, P. G., Galazios, G. C., Tsikouras, P. N., & Liberis, V. A. (2000). Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. European journal of gynaecological oncology, 21(2), 180–183.
4. Bueloni-Dias, F. N., Spadoto-Dias, D., Nahás Neto, J., & Nahás, E. A. P. (2014). Predictive factors for occurrence of endometrial polyps in postmenopausal women. Revista Brasileira de Ginecologia e Obstetrícia, 36(11), 489–496.
5. Dreisler, E., Stampe Sorensen, S., Ibsen, P. H., & Lose, G. (2009). Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound in obstetrics & gynecology, 33(1), 102–108.
6. Goldstein SR, Monteagudo A, Popiolek D, Mayberry P, Timor-Tritsch I. Evaluation of endometrial polyps. Am J Obstet Gynecol. 2002;186(4):669–74.
7. DeWaay, D. J., Syrop, C. H., Nygaard, I. E., Davis, W. A., & Van Voorhis, B. J. (2002). Natural history of uterine polyps and leiomyomata. Obstetrics & Gynecology, 100(1), 3–7.
8. de Azevedo, J. M. D. R., de Azevedo, L. M. D. R., Freitas, F., & Wender, M. C. O. (2016). Endometrial polyps: when to resect?. Archives of Gynecology and Obstetrics, 293(3), 639–643.
9. Jayaprakasan, K., Polanski, L., Sahu, B., Thornton, J. G., & Raine‐Fenning, N. (2014). Surgical intervention versus expectant management for endometrial polyps in subfertile women. The Cochrane Library.
10. Wada-Hiraike, O., Osuga, Y., Hiroi, H., Fujimoto, A., Maruyama, M., Yano, T., & Taketani, Y. (2011). Sessile polyps and pedunculated polyps respond differently to oral contraceptives. Gynecological Endocrinology, 27(5), 351–355.
11. de Los Rios, P. J., López, R. C., Cifuentes, P. C., Angulo, C. M., & Palacios-Barahona, A. U. (2015). [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding]. Ginecologia y obstetricia de Mexico, 83(7), 422–428.
12. Fraser, I. S. (1990). Hysteroscopy and laparoscopy in women with menorrhagia. American journal of obstetrics and gynecology, 162(5), 1264–1269.
13. Darrow SL, Vena JE, Batt RE, Zielezny MA, Michalek AM, Selman S. Menstrual cycle characteristics and the risk of endometriosis. Epidemiology. 1993;4(2):135–42.
14. Nuovo, M. A., Nuovo, G. J., McCaffrey, R. M., Levine, R. U., Barron, B., & Winkler, B. (1989). Endometrial polyps in postmenopausal patients receiving tamoxifen. International journal of gynecological pathology, 8(2), 125–131.
15. Rackow, B. W., Jorgensen, E., & Taylor, H. S. (2011). Endometrial polyps affect uterine receptivity. Fertility and sterility, 95(8), 2690–2692.
16. Serhat, E., Cogendez, E., Selcuk, S., Asoglu, M. R., Arioglu, P. F., & Eren, S. (2014). Is there a relationship between endometrial polyps and obesity, diabetes mellitus, hypertension?. Archives of gynecology and obstetrics, 290(5), 937–941.
17. Pandey, S., & Bhattacharya, S. (2010). Impact of obesity on gynecology. Women’s Health, 6(1), 107–117.
18. Bakour, S. H., Gupta, J. K., & Khan, K. S. (2002). Risk factors associated with endometrial polyps in abnormal uterine bleeding. International Journal of Gynecology & Obstetrics, 76(2), 165–168.
19. Gao, W., Zhang, L., Li, W., Li, J., Wang, W., Zhao, W., & Feng, L. (2012). Three-year follow-up results of polypectomy with endometrial ablation in the management of endometrial polyps associated with tamoxifen in Chinese women. European Journal of Obstetrics & Gynecology and Reproductive Biology, 161(1), 62–65.
20. Vercellini, P., Vendola, N., Ragni, G., Trespidi, L., Oldani, S., & Crosignani, P. G. (1993). Abnormal uterine bleeding associated with iron-deficiency anemia. Etiology and role of hysteroscopy. The Journal of reproductive medicine, 38(7), 502–504.
21. Puchar, A., Feyeux, C., Luton, D., & Koskas, M. (2015). Therapeutic management of uterine fibroid tumors. Minerva ginecologica.
22. Worldwide, A. A. M. I. G. (2012). AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. Journal of Minimally Invasive Gynecology, 19(1), 3–10.
23. Onalan, R., Onalan, G., Tonguc, E., Ozdener, T., Dogan, M., & Mollamahmutoglu, L. (2009). Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization. Fertility and sterility, 91(4), 1056–1060.
