Endometrial Polyp on Ultrasound: What Does It Mean and What Happens Next?

An endometrial polyp on ultrasound means the scan has shown what looks like a growth of the womb lining (endometrium) projecting into the womb. These polyps are common and most are not cancer. The care team usually confirms the finding and decides on removal or watchful waiting based on symptoms, age and menopausal status.

MedlinePlus describes polyps as fingerlike growths attached to the inner wall of the uterus, formed when the lining overgrows. They can be as small as a sesame seed or larger than a golf ball, and there may be one or several. Reports may also call them uterine polyps.

Get advice urgently, from an urgent care service or an emergency department, if you have:

• bleeding that is suddenly much heavier than usual
• heavy bleeding with dizziness or weakness, which can be signs of anaemia
• heavy bleeding with fainting or severe pain (call your local emergency number)
• after a hysteroscopy: bleeding that gets worse or does not stop after a few days, worsening pain that painkillers do not help, a high temperature or smelly vaginal discharge

The NHS advises seeing a GP about any vaginal bleeding after menopause, even if it is light or happened only once. Cleveland Clinic defines postmenopausal bleeding as bleeding a year or more after the last period, and includes spotting or brown discharge.

Polyps are a common and usually non-cancerous cause. The NHS also lists thinning or thickening of the womb lining and, less often, womb cancer. Postmenopausal bleeding is not usually serious, but it should be checked because it can be a sign of cancer. In the UK, people referred for it should be seen by a specialist within two weeks.

Tests may include a vaginal ultrasound, an examination, and a hysteroscopy, often with a biopsy (a small tissue sample). If your scan also mentions lining thickness, our guide on thickened endometrium explains that separately.

Polyps are common.The exact cause is not known, but they tend to grow when oestrogen levels are higher.

Factors linked with polyps include obesity, tamoxifen or similar breast cancer medicines, hormone replacement therapy after menopause, and a family history of Lynch or Cowden syndrome. Do not stop or change tamoxifen, HRT or any prescribed medicine because of a scan report. Talk to your prescriber first.

When symptoms occur, MedlinePlus lists:

• irregular periods or heavy periods
• bleeding between periods
• bleeding after menopause
• difficulty getting pregnant or staying pregnant

Most are not. MedlinePlus states that most endometrial polyps are not cancerous, but they can be precancerous or cancerous. The risk is higher after menopause, in people taking tamoxifen, and in people with heavy or irregular periods.

An ultrasound cannot tell a benign polyp from an abnormal one. Only a tissue sample, examined under a microscope, can do that. This is why many polyps are removed and sent to the laboratory, especially when they cause bleeding.

If a polyp is removed, ask what the laboratory report says. A benign result usually settles the question for that polyp. If the report shows abnormal or precancerous cells, the team will explain what further tests or treatment they advise, and why.

Not always. Cleveland Clinic notes that some small polyps disappear on their own, and small polyps without symptoms may be watched to check they are not growing. MedlinePlus says people after menopause without symptoms may consider watchful waiting, but a polyp causing bleeding should be removed.

If pregnancy is a goal, tell the team, because plans can be shaped around fertility. Before deciding, the clinician may confirm the polyp with saline infusion sonography, a scan with fluid placed in the womb, or with a hysteroscopy.

MedlinePlus notes that polyps rarely come back after treatment. Ask whether any follow-up is planned once the laboratory result is known.

A hysteroscopy passes a thin telescope through the cervix to look inside the womb. If a polyp is found, it can often be removed during the same procedure if you agree. Many clinics do this as an outpatient procedure while you are awake.

The NHS and RCOG describe options such as taking pain relief about an hour beforehand, local anaesthetic, or gas and air. You can also choose a general anaesthetic or sedation, although not every clinic offers it. During an outpatient procedure you can ask to stop at any time.

Risks are uncommon. They include infection and, rarely, a small hole in the womb wall. The NHS says period-like pain for a couple of days and spotting for up to a week are expected afterwards.

Tell the team in advance if you have painful periods that make you faint, have found internal examinations very painful, or have experienced sexual violence. The NHS suggests mentioning this so the clinic can plan the most suitable approach. Use pads rather than tampons until bleeding stops.

Bring the full scan report and a note of your bleeding pattern and medicines.

• How sure is the scan that this is a polyp? Do I need a saline scan or hysteroscopy to confirm it?
• Given my age, symptoms and medicines, do you advise removal or watchful waiting?
• Can the polyp be removed as an outpatient, and what pain relief or anaesthetic options are there?
• Will the tissue be sent to the laboratory, and how will I get the result?
• Does this affect my plans for pregnancy?
• Which symptoms should make me contact you before my next appointment?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with a similar scan finding talked through removal or monitoring can help you prepare questions and understand the options more clearly. Other people's cases cannot diagnose a polyp or predict your result. Your gynaecology team must make the decisions with you. If heavy periods continue after a normal scan, our guide on heavy periods with a normal ultrasound may also help.