A little blood in your underwear, mid-cycle. Or after sex. It is too little to worry about, you think, and too frequent to ignore. A polyp in your uterus is one of the most commonly missed explanations for exactly that pattern.
Good news first, because you deserve to hear it before you read on. In an analysis of more than 35,000 women, 2.73 percent of removed polyps turned out to be malignant, and in women before menopause only 1.12 percent (Uglietti, 2019). The vast majority are simply benign.
That does not mean you should leave it be. Below you read why.
What is a uterine polyp?
A uterine polyp is a benign outgrowth of your womb lining, which grows into the uterine cavity like a small knob or stalk. They are usually a few millimetres to a couple of centimetres in size. Polyps are sensitive to oestrogen, which is why they occur more often around menopause.
You can have one, or several at the same time.
An important difference from a fibroid: a polyp grows out of the lining, a fibroid out of the muscle layer. They feel different in the complaints they cause, although that difference can never be settled on symptoms alone.
What are the symptoms of a uterine polyp?
The most common symptom of a uterine polyp is irregular bleeding: spotting between your periods, bleeding after sex, or a period that has become heavier and longer. Many polyps cause no complaints at all and are found by chance. Bleeding after menopause belongs on the list too, and that always calls for investigation.
The pattern is therefore often irregular, not necessarily heavy.
The table below sets the complaints next to what they can mean and what you do about them.
| What you notice | What it can mean | What you do |
|---|---|---|
| Spotting between two periods | Fits a polyp, but also hormonal fluctuations | Track two cycles and discuss it with your GP |
| Bleeding after sex | A polyp can bleed when touched | Make an appointment with your GP |
| A period that has become heavier or longer | Can point to a polyp, fibroid or adenomyosis | Have your Hb and ferritin assessed too |
| Bleeding when you are through menopause | Always calls for investigation, whatever the amount | Make an appointment soon |
| Trouble getting pregnant | A polyp can affect implantation | Discuss it in your fertility pathway |
What strikes me here is how often spotting is dismissed as "just your hormones". Sometimes that is right. But it is worth having the distinction made by someone who can look.
How is a polyp diagnosed?
A polyp is seen with imaging, not with blood tests. The gynaecologist starts with an internal ultrasound, on which a thickened womb lining or the knob itself can be visible. For certainty a hysteroscopy often follows: a thin viewing tube with which the doctor looks directly into your uterine cavity and can usually remove the polyp at once.
That removed tissue goes to the laboratory, and there it is examined.
This is what the path usually looks like:
- GP: you discuss your bleeding pattern, often a referral follows
- Internal ultrasound: the gynaecologist assesses the lining and the cavity
- Hysteroscopy: looking and usually removing in the same procedure
- Tissue examination: the laboratory assesses the removed tissue
Prepare for your appointment with concrete details. Note down over a cycle or two when you bleed, how much, and whether it is linked to sex. That is exactly the information on which the decision about an ultrasound is made.
What do blood tests add with a polyp?
Blood tests cannot detect or rule out a polyp. What they do is make the consequences of the bleeding visible. Uterine conditions are a common cause of iron deficiency in women, even when the bleeding itself does not look dramatic (Donnez, 2022).
With a polyp in particular I see this underestimated, because the bleeding is often "just some spotting".
Imagine losing a little extra blood on 10 days per cycle, 12 cycles a year. That adds up. Your ferritin can then sit at 13 µg/l while your Hb of 7.7 mmol/l is still neatly normal. That explains why you are tired without anyone finding anything.
Where blood tests help you:
- Ferritin: shows whether your iron store has been affected, even with a normal Hb
- Hb and blood count: show whether anaemia has developed
- Thyroid (TSH): a thyroid problem can also cause irregular bleeding
The Anemia panel measures Hb, ferritin and the blood count in one draw. If you only want to know how your iron store is doing, the Iron status is enough. Neither says anything about the polyp itself.
Read our pillar adenomyosis: symptoms, diagnosis and what blood tests add too, because the complaints overlap. And if anaemia is your main worry: anaemia from heavy periods explains the link step by step.
Is a uterine polyp dangerous?
A uterine polyp is nearly always benign. In the meta-analysis by Uglietti, 2.73 percent of polyps turned out to be malignant or a precursor, and in women before menopause 1.12 percent (Uglietti, 2019). The risk is higher in women after menopause and in women with bleeding. That is exactly why a polyp is usually removed and examined.
Removal is therefore not panic, but care.
The NHG guideline on vaginal bleeding describes how Dutch GPs handle irregular bleeding, and Thuisarts.nl translates that into plain language. Both are free and give you something to hold on to for your appointment.
Frequently asked questions
Can you feel a uterine polyp?
No, you cannot feel a polyp yourself. You notice it through the bleeding pattern: spotting between periods, blood after sex or a period that has become heavier. A polyp is seen on an internal ultrasound or during a hysteroscopy.
Does a polyp always have to be removed?
Not always. With complaints, with bleeding after menopause or with a wish to conceive, a polyp is usually removed and the tissue examined. If a small polyp causes no complaints, watchful waiting can be an option. You make that decision together with your gynaecologist.
Can you get pregnant with a polyp?
You can, although a polyp can affect the implantation of an embryo. With a wish to conceive or in a fertility pathway, removal is therefore often advised. Discuss your situation with your gynaecologist.
References
- Uglietti A, et al. The risk of malignancy in uterine polyps: a systematic review and meta-analysis. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2019. PMID 31009859.
- Clarke MA, et al. Association of endometrial cancer risk with postmenopausal bleeding in women: a systematic review and meta-analysis. JAMA Internal Medicine, 2018. PMID 30083701.
- Donnez J, et al. Uterine disorders and iron deficiency anemia. Fertility and Sterility, 2022. PMID 36182260.
- NHG. NHG guideline on vaginal bleeding. Dutch College of General Practitioners. Available via richtlijnen.nhg.org.
- Thuisarts.nl. I have bleeding between my periods. Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For the assessment of a polyp, discuss your symptoms with your GP or gynaecologist.
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Lunarahealth
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