It starts with a period that lingers a few days longer than usual. Then, perhaps, spotting appears mid-cycle, staining your favourite underwear when you least expect it. At first, it is easy to dismiss these irregularities as stress or a hormonal blip. But when unpredictable bleeding becomes the new normal, it can be both frustrating and frightening.
Abnormal uterine bleeding is one of the most common reasons women seek medical advice. While there are many potential causes, one frequent culprit often flies under the radar: uterine polyps.
These small, soft growths can wreak havoc on a menstrual cycle, yet many women have never heard of them until they are sitting in a doctor’s office. This article aims to demystify uterine polyps, explaining what they are, why they cause bleeding issues, and how they can be effectively managed.
What Are Uterine Polyps?
To understand polyps, imagine the lining of the uterus (the endometrium). This is the tissue that thickens each month in preparation for pregnancy and sheds during menstruation if conception doesn’t occur.
Sometimes, an overgrowth of cells occurs within this lining. These overgrowths form polyps—small, bulbous tissue masses attached to the inner wall of the uterus. They can be attached by a large base or a thin stalk, hanging like a teardrop or a grape.
Uterine polyps (also called endometrial polyps) range drastically in size. Some are as tiny as a sesame seed, while others can grow to the size of a golf ball or larger. A woman might have a solitary polyp or multiple growths crowding the uterine cavity.
Unlike fibroids, which are made of muscle tissue, polyps are made of endometrial tissue. While the vast majority of polyps are benign (non-cancerous), they do carry a small risk of malignancy or pre-cancerous changes, particularly in postmenopausal women.
The Connection to Abnormal Bleeding
The most defining symptom of uterine polyps is irregular bleeding. Because polyps are essentially fragile outgrowths of the uterine lining, they are prone to irritation and shedding outside of the normal menstrual schedule.
Here is how they typically disrupt bleeding patterns:
1. Irregular Menstrual Cycles
Women with polyps often find their periods become unpredictable. You might have a cycle that lasts 24 days one month and 35 the next. The bleeding might start and stop, or involve days of spotting followed by heavy flow.
2. Intermenstrual Bleeding (Spotting)
This is a classic sign. Because polyps dangle into the uterine cavity, they can be easily disturbed. This can lead to spotting or light bleeding between periods. If you find yourself needing to wear a pantyliner every day “just in case,” polyps could be the cause.
3. Heavy Menstrual Bleeding (Menorrhagia)
Polyps increase the surface area of the uterine lining. They can also prevent the uterus from contracting efficiently to stop menstrual bleeding. This can result in exceptionally heavy periods, where you soak through sanitary products rapidly or pass large clots. Over time, this heavy blood loss can lead to iron-deficiency anaemia, leaving you feeling exhausted and breathless.
4. Postmenopausal Bleeding
This is a critical red flag. Once a woman has gone through menopause (defined as 12 consecutive months without a period), any vaginal bleeding is considered abnormal. Uterine polyps are a common cause of this bleeding, but because the risk of uterine cancer increases with age, postmenopausal bleeding must always be investigated immediately.
Other Symptoms to Watch For
While abnormal bleeding is the headline symptom, polyps can manifest in other ways, or sometimes not at all.
- Infertility: Polyps can act as a natural contraceptive device. Depending on their location, they can block the fallopian tubes or prevent a fertilised egg from implanting in the uterine wall. Removal of polyps is often a first step in fertility treatment for women struggling to conceive.
- Vaginal Discharge: Occasionally, a large polyp can become infected or necrotic, leading to a foul-smelling vaginal discharge.
However, it is worth noting that many small polyps are completely asymptomatic. They are often discovered incidentally during an ultrasound or pelvic exam for an unrelated issue.
Risk Factors: Who Gets Them?
Scientists aren’t entirely sure why some women develop polyps and others don’t, but hormonal factors appear to play a significant role. Polyps are oestrogen-sensitive, meaning they grow in response to circulating oestrogen.
You may be at higher risk if you:
- Are perimenopausal or postmenopausal.
- Have high blood pressure (hypertension).
- Are obese (fat tissue produces extra oestrogen).
- Take tamoxifen, a drug used to treat breast cancer.
Diagnosis: Seeing Is Knowing
Because symptoms like heavy bleeding overlap with other conditions (such as fibroids or endometriosis), you cannot diagnose polyps based on symptoms alone. You need a look inside the uterus.
If you consult a doctor about abnormal bleeding, the diagnostic process usually involves:
1. Transvaginal Ultrasound
This is the standard first-line test. A slender wand-like device is inserted into the vagina, emitting sound waves to create an image of your uterus. A doctor can often see polyps as thickenings or distinct masses within the uterine cavity.
2. Hysteroscopy
This is the gold standard for both diagnosis and treatment. A doctor inserts a thin, lighted telescope (hysteroscope) through the vagina and cervix into the uterus. This allows them to examine the inside of the uterus directly on a screen. If polyps are found, they can often be removed during the same procedure.
3. Endometrial Biopsy
Your doctor might use a small suction catheter to take a sample of the uterine lining to test for cancerous cells.
Treatment: To Remove or Not to Remove?
Not all polyps require aggressive treatment. If you have small polyps that aren’t causing symptoms and you don’t have risk factors for uterine cancer, your doctor might recommend a “watch and wait” approach. Small polyps can sometimes resolve on their own.
However, treatment is generally recommended if:
- You are experiencing symptoms (heavy bleeding, spotting, etc.).
- You are postmenopausal.
- The polyps are large or look atypical.
- You are trying to conceive.
Polypectomy (Removal)
The most common treatment is a hysteroscopic polypectomy. This is a minimally invasive procedure performed via the cervix, meaning there are no cuts or scars. Instruments are passed through the hysteroscope to cut or shave off the polyp. The tissue is then sent to a lab to confirm it is benign.
This procedure is usually done as a day case, and recovery is quick. Most women are back to their normal activities within a day or two, often finding that their bleeding patterns return to normal almost immediately.
Why Specialist Care Matters
Abnormal bleeding can be disruptive, embarrassing, and exhausting. It impacts your work, your social life, and your intimate relationships. But you do not have to “just live with it.”
If your periods have changed, or if you are spotting when you shouldn’t be, it is vital to seek professional advice. A general practitioner is a good starting point, but for specific uterine issues, seeing a specialist a specialist ensures you get access to the most accurate diagnostic tools and the full range of treatment options. If you need focused care for uterine issues like polyps or abnormal bleeding, consider booking a consultation directly with a gynae who can provide the expert guidance and treatments you need. ensures you get access to the most accurate diagnostic tools and the full range of treatment options.
Conclusion
Uterine polyps are common, treatable, and usually benign. However, their impact on a woman’s quality of life can be significant. They turn the predictable rhythm of a menstrual cycle into a source of stress and uncertainty.
By recognising the signs—particularly the hallmark of erratic or heavy bleeding—you empower yourself to seek help. Medical intervention for polyps is often simple and highly effective, allowing you to stop worrying about your cycle and get back to living your life. If your body is sending you signals through abnormal bleeding, listen to it. Early diagnosis brings peace of mind and, crucially, relief.