Endometrial Polyps: Symptoms, Diagnosis, and Treatment in New York City

An endometrial polyp is a soft, fleshy overgrowth of the uterine lining that projects into the uterine cavity. Polyps are among the most common gynecologic findings, and they are one of the most frequently identified causes of abnormal uterine bleeding in women of all reproductive ages, including those approaching and beyond menopause.

Most endometrial polyps are benign. But “benign” does not mean inconsequential. They can cause irregular or heavy bleeding that disrupts your schedule, create significant uncertainty when discovered on imaging, and in some cases interfere with fertility and implantation. They also require pathologic analysis after removal to confirm their nature with certainty.

At Kim Gyn on Park Avenue in the Upper East Side, Dr. Kim offers in-office diagnostic hysteroscopy and outpatient hysteroscopic polypectomy, the gold standard treatment, so that evaluation and treatment can take place efficiently and with minimal disruption to your life.

What Is an Endometrial Polyp?

An endometrial polyp is an overgrowth of endometrial glands and stroma (the supporting tissue of the uterine lining) that forms a localized protrusion into the uterine cavity. Polyps can be sessile (flat and broad-based) or pedunculated (attached by a narrow stalk). They range in size from a few millimeters to several centimeters. Most are solitary, but multiple polyps can occur simultaneously. The vast majority are benign, but a small percentage can contain atypical or precancerous cells, which is why removal and pathologic analysis are recommended in most cases.

Endometrial polyps are sometimes also called uterine polyps. The two terms refer to the same condition and are used interchangeably.

The growth of polyps is driven primarily by estrogen, which stimulates proliferation of the uterine lining. Areas of the lining that are more sensitive to estrogen stimulation, or that have small localized hormonal changes, can overgrow into a polyp while the surrounding lining behaves normally. This hormonal dependency explains why polyps are most common during the perimenopausal years, when estrogen levels fluctuate significantly, and in women taking tamoxifen, a medication that has estrogen-like effects on the uterus.

What Causes Endometrial Polyps?

The precise mechanism that initiates polyp formation is not fully established. The following are the best-understood contributing factors.

• Estrogen stimulation: Excess or prolonged exposure to estrogen, whether from the body’s own production or from external sources, encourages the uterine lining to grow and can contribute to localized overgrowth. This is the primary hormonal driver of polyp formation.
• Perimenopausal hormonal fluctuation: The years surrounding menopause involve significant irregularity in estrogen and progesterone levels. This hormonal variability creates conditions in which focal overgrowth of the uterine lining is more likely. Polyps are most commonly diagnosed in women in their forties and early fifties.
• Tamoxifen use: Tamoxifen, used in the treatment and prevention of estrogen-receptor-positive breast cancer, has estrogenic effects specifically on the uterine lining. Women on tamoxifen have a substantially elevated risk of developing endometrial polyps, as well as a modestly elevated risk of those polyps containing atypical cells.
• Obesity: Adipose (fat) tissue produces estrogen independently of the ovaries. Higher body fat levels therefore create a chronic estrogen-rich environment that can stimulate endometrial overgrowth.
• Polycystic ovary syndrome (PCOS): PCOS is associated with relative progesterone deficiency, which allows estrogen to stimulate the uterine lining without the counterbalancing effect of progesterone. This creates conditions favorable to polyp development.
• Hypertension: An association between hypertension and endometrial polyps has been observed in clinical studies, though the mechanism is not fully understood.

Endometrial Polyp Symptoms

Many women with endometrial polyps have no symptoms at all. Polyps are frequently discovered incidentally during an ultrasound or evaluation for another reason. When endometrial polyp symptoms do occur, abnormal uterine bleeding is by far the most common presentation. Other common symptoms include:

• Bleeding between periods (intermenstrual spotting or bleeding)
• Heavier or more prolonged periods than your usual baseline
• Irregular or unpredictable menstrual cycles
• Postmenopausal bleeding (any vaginal bleeding after menopause is abnormal and requires evaluation)
• Spotting or light bleeding after sexual intercourse
• Difficulty conceiving or unexplained infertility

Postmenopausal bleeding should never be assumed to be benign without evaluation. While an endometrial polyp is the most common explanation, postmenopausal bleeding can also be a sign of endometrial hyperplasia or endometrial cancer. Prompt investigation by a gynecologist is essential.

Are Endometrial Polyps Painful?

Most endometrial polyps do not cause pelvic pain. The primary clinical presentation is abnormal bleeding rather than discomfort. In rare cases, a large polyp or one that protrudes through the cervix can cause cramping or a sensation of pressure. If you are experiencing significant pelvic pain alongside abnormal bleeding, additional evaluation is warranted to assess for other concurrent conditions such as fibroids, adenomyosis, or endometriosis.

Endometrial Polyps and Fertility

Endometrial polyps are identified in a meaningful proportion of women being evaluated for unexplained infertility. Polyps are thought to interfere with fertility by creating a mechanical barrier to sperm transport, disrupting implantation by altering the uterine environment, or triggering an inflammatory response within the uterine cavity.

The evidence supporting polypectomy as a fertility-improving intervention is strong: removal of endometrial polyps before intrauterine insemination (IUI) or in vitro fertilization (IVF) has been shown to significantly improve pregnancy rates in multiple clinical studies. For women planning to conceive, polyp removal is generally recommended before fertility treatment begins.

How are Endometrial Polyps Diagnosed?

Endometrial polyps cannot be detected during a standard pelvic examination. Because they are located inside the uterine cavity, diagnosis requires imaging or direct visualization.

Transvaginal Ultrasound

Transvaginal ultrasound is typically the first imaging step in the evaluation of abnormal uterine bleeding. The probe is placed in the vagina to provide a detailed view of the uterus and its lining. A polyp may appear as a thickened or irregular area of the endometrium, or as a discrete echogenic (bright) focus within the uterine cavity. The sensitivity of standard transvaginal ultrasound for detecting polyps is moderate and depends on the timing within the menstrual cycle and the experience of the examiner.

Sonohysterography (Saline Infusion Sonogram)

Sonohysterography improves the accuracy of ultrasound for detecting intrauterine lesions. A small amount of sterile saline is introduced into the uterine cavity through a thin catheter before the ultrasound is performed. The fluid creates a contrast medium that outlines the cavity, making polyps and other lesions much more visible. This is a more sensitive diagnostic step than standard transvaginal ultrasound alone when polyps are suspected but not clearly seen.

Hysteroscopy

Hysteroscopy is the gold standard for diagnosing endometrial polyps. A thin, lighted camera (a hysteroscope) is passed through the cervix directly into the uterine cavity, allowing the physician to visualize the entire uterine lining in real time under direct magnification. Unlike ultrasound, hysteroscopy can definitively confirm the presence of a polyp, characterize its size and location, and, critically, facilitate its removal in the same procedure.

At Kim Gyn, diagnostic hysteroscopy can be performed in the office. For patients who are found to have a polyp during diagnostic evaluation, removal (hysteroscopic polypectomy) can frequently be performed as a same-day outpatient procedure, eliminating the need for a separate visit or surgery.

Endometrial Polyp Treatment Options

Watchful Waiting

For small polyps (generally under 1 centimeter) discovered incidentally in premenopausal women with no symptoms, watchful waiting with repeat ultrasound at a defined interval is a reasonable initial approach. Studies show that a subset of small functional polyps resolve spontaneously within a few menstrual cycles without intervention. If the polyp persists, grows, or causes symptoms, removal is then recommended.

Watchful waiting is generally not appropriate for women with symptomatic polyps, for any polyp found in a postmenopausal woman, for women on tamoxifen, for women experiencing unexplained infertility, or when ultrasound features raise concern.

Hysteroscopic Polypectomy

Hysteroscopic polypectomy is the gold standard treatment for endometrial polyps. It is minimally invasive, highly accurate, and allows the removed tissue to be sent immediately for pathologic analysis. The procedure is performed under direct visualization, eliminating the guesswork of older approaches.

How the procedure works:

Using the hysteroscope to visualize the polyp directly, Dr. Kim introduces small specialized instruments through the instrument channel of the hysteroscope. The polyp is grasped at its base or stalk and removed cleanly and completely. All excised tissue is sent to a pathology laboratory for analysis, which confirms whether the polyp is benign, contains atypical cells, or in rare cases shows evidence of malignancy. The procedure is performed under local anesthesia or light sedation in an outpatient setting.

What to expect:

• The procedure takes approximately 15 to 30 minutes
• No external incisions are made
• Most patients experience mild cramping for a few hours afterward, similar to period cramps
• Light spotting or discharge for a few days following the procedure is normal
• Return to normal daily activities within one to two days for most patients
• Results from pathology are typically available within one to two weeks

Why hysteroscopic polypectomy is preferred over alternatives:

The precision of direct visualization ensures complete removal of the polyp, which is not reliably achievable with older approaches. It also generates a tissue sample that can be analyzed immediately, providing diagnostic certainty alongside treatment. Most importantly, it resolves the abnormal bleeding in the majority of cases.

Why Dilation and Curettage (D&C) Is No Longer the Standard

Dilation and curettage (D&C) is an older procedure in which the uterine lining is scraped without direct visualization using a camera. While D&C remains appropriate in certain clinical contexts, it is not the recommended approach for endometrial polyp removal. Research has demonstrated that D&C misses polyps in up to 50 percent of cases because the instrument cannot be directed toward a specific lesion without being able to see it. Treating a polyp that has not been visualized directly is not reliable management, and it does not provide the complete tissue sample required for pathologic analysis of the specific lesion. Hysteroscopic polypectomy is unambiguously superior for this indication.

Hormonal Treatment

Progestins and combined hormonal contraceptives can temporarily suppress the growth of the uterine lining and reduce bleeding symptoms. They do not reliably eliminate existing polyps and are not a definitive treatment for endometrial polyps. Hormonal management may be used as a short-term bridge in specific circumstances or to manage symptoms while surgical scheduling is arranged, but it is not a substitute for removal when removal is indicated.

Endometrial Polyps and Abnormal Uterine Bleeding

Abnormal uterine bleeding is the most common reason women are evaluated for endometrial polyps, and polyps are found in up to 25 percent of women undergoing investigation for this symptom. What makes abnormal uterine bleeding an important symptom to take seriously is not just the disruption it causes to daily life, but the fact that it can signal a range of conditions with different clinical implications.

Other causes of abnormal uterine bleeding include uterine fibroids, adenomyosis, endometrial hyperplasia, and, less commonly, endometrial cancer. Because these conditions can co-exist with polyps and because abnormal bleeding warrants proper evaluation regardless of the underlying cause, a thorough assessment by a gynecologist who can perform diagnostic hysteroscopy is the appropriate and most efficient path to an answer.

Questions to Ask During Your Consultation

• Based on my ultrasound findings, is a polyp likely?
• Is my abnormal bleeding most likely caused by the polyp, or should other causes be investigated at the same time?
• Am I a candidate for in-office hysteroscopy and same-day polypectomy?
• What will the removed tissue be tested for, and when will I receive results?
• If the pathology shows any atypical cells, what are the next steps?
• Given my age and symptoms, is watchful waiting a reasonable option for me, or is removal recommended now?
• Could my fertility be affected by the polyp, and would removal improve my chances of conceiving?

Why Choose Dr. Kim for Endometrial Polyp Diagnosis and Treatment?

At Kim Gyn, the evaluation and treatment of endometrial polyps is handled with the efficiency, precision, and direct physician access that the condition deserves. For a condition this common and this effectively treated when properly managed, the experience of care should reflect that clarity.

• You work exclusively with Dr. Kim at every appointment, from initial evaluation through any procedure and follow-up
• In-office diagnostic hysteroscopy and outpatient hysteroscopic polypectomy are available, meaning diagnosis and treatment can often be completed without multiple separate visits
• All removed tissue is sent for pathologic analysis as standard practice, providing definitive diagnostic certainty alongside symptom relief
• Direct call and text access to Dr. Kim between appointments for any questions about your results or recovery
• Evaluation considers the full clinical picture, including co-existing conditions such as fibroids, adenomyosis, and abnormal uterine bleeding from multiple sources
• A private, self-pay practice model means your evaluation is not time-limited by insurance protocols and your questions receive complete answers

Kim Gyn is located at 877 Park Avenue in the Upper East Side, easily accessible to patients throughout Manhattan.

Schedule a Consultation for Endometrial Polyp Evaluation

If you are experiencing abnormal uterine bleeding, have been told a polyp was seen on ultrasound, or are planning fertility treatment and want a complete evaluation of your uterine cavity, we encourage you to reach out.

Frequently Asked Questions About Endometrial Polyps

What are the most common endometrial polyp symptoms?

The most common symptom of endometrial polyps is abnormal uterine bleeding, which can present as spotting between periods, heavier or longer periods than usual, irregular cycles, postmenopausal bleeding, or light bleeding after sex. Many women with polyps have no symptoms at all, and the polyp is found incidentally on imaging. Polyps rarely cause significant pain. Unexplained infertility is also associated with polyps in some patients.

Are endometrial polyps cancerous?

The overwhelming majority of endometrial polyps are benign. However, a small percentage can contain atypical or precancerous cells, and an even smaller percentage may harbor early endometrial cancer. The risk of malignancy is higher in postmenopausal women, women on tamoxifen, and women with risk factors for endometrial cancer. This is one of the primary reasons removal and pathologic analysis are recommended rather than indefinite observation in most cases.

Do endometrial polyps need to be removed?

Not always. Small, asymptomatic polyps in premenopausal women may be monitored initially, as some resolve spontaneously. However, removal is generally recommended when a polyp causes symptoms such as abnormal bleeding, when it is found in a postmenopausal woman, when a woman is taking tamoxifen, when infertility is a concern, or when imaging features raise any uncertainty. Removal provides both treatment and diagnostic certainty through pathologic analysis of the tissue.

What is a hysteroscopic polypectomy and what is recovery like?

Hysteroscopic polypectomy is the gold standard procedure for removing endometrial polyps. A thin camera is passed through the cervix into the uterine cavity, and small instruments are used to remove the polyp under direct visualization. No external incisions are required. The procedure typically takes 15 to 30 minutes. Most patients experience mild cramping for a few hours afterward and light spotting for a few days. The majority of women return to normal activities within one to two days.

Can endometrial polyps come back after removal?

Polyp recurrence is possible. Studies report recurrence rates of roughly 15 to 20 percent over several years following hysteroscopic polypectomy. The recurrence risk is influenced by the underlying hormonal environment, so women with persistent estrogen dominance, PCOS, obesity, or those on tamoxifen may be more prone to developing new polyps over time. Follow-up ultrasound imaging and routine gynecologic monitoring are appropriate after polypectomy.

Can an endometrial polyp cause infertility?

Yes. Endometrial polyps are found in a meaningful proportion of women investigated for unexplained infertility, and there is good clinical evidence that removing polyps before fertility treatment such as IUI or IVF improves pregnancy rates. The polyp is believed to interfere with implantation by creating mechanical disruption of the uterine lining or by generating a local inflammatory environment. For women planning to conceive, evaluation of the uterine cavity for polyps is an important step before fertility treatment begins.

Is a D&C the same as a hysteroscopic polypectomy?

No. A dilation and curettage (D&C) is a procedure in which the uterine lining is scraped without direct visual guidance. While it was historically the standard approach, studies show D&C misses polyps in up to 50 percent of cases because the physician cannot see inside the cavity to target the specific lesion. Hysteroscopic polypectomy is performed under direct visualization with a camera, which ensures the polyp is identified accurately, removed completely, and sent for pathologic analysis. The two procedures are not equivalent.

What does postmenopausal bleeding mean if I have a polyp?

Any vaginal bleeding after menopause requires prompt evaluation regardless of the suspected cause. While an endometrial polyp is the most common explanation for postmenopausal bleeding, this symptom can also be caused by endometrial hyperplasia or endometrial cancer. It should never be assumed to be benign without investigation. A thorough evaluation including imaging and typically hysteroscopy is appropriate. If a polyp is found, it should be removed and sent for pathologic analysis to definitively confirm its nature.