The lining of the womb changes in thickness with each period because of the female hormones. There can be areas that do not react to this normal cycle. These areas form thick knobs, called polyps, that continue to grow. If a woman does not become pregnant, the endometrial lining sheds, causing a menstrual period. After a period, the lining grows rapidly under the influence of hormones such as estrogen. Polyps are areas that grow a little too much. As they grow, they usually fan out but remain attached to a small stalk, almost like a tree. The stalk is like the trunk of a tree, while the larger part of the polyp is like the branches. They are usually about the size of a pencil eraser, although they can be even smaller. Rarely, polyps can grow as large as an orange.
When symptoms do occur, they usually include excessive bleeding during a menstrual period, or bleeding in between periods, or even spotting after intercourse. Some women report a few days of brown blood after a normal menstrual period. Polyps cause these symptoms because they dangle from their stalks and irritate the surrounding tissue, which causes tissue to rub off, exposing tiny blood vessels. These blood vessels bleed, leading to spotting or vaginal bleeding.
Another diagnostic test is a hysterosalpingogram (HSG), which uses dye under pressure to open the uterus and tubes. A quick X-ray is then taken to see if any polyps are in the uterus. Finally, gynecologists are becoming more skilled at using the hysteroscope to look inside the uterus. This is a small, lighted tube that goes into the vagina then the uterus, to look around inside the uterus. Hysteroscopy using small tubes can be performed in the office, but larger tubes (used to remove large polyps or fibroids) usually require anesthesia in the hospital.
Hysteroscopes now allow us to look right at the polyp as we grasp it or cut it away from the uterine lining. This ensures that the polyp (or, in some cases, multiple polyps) is removed.
In some women, if the polyp(s) interfere with the egg and sperm, it may make it hard to get pregnant. It is unknown at the time of writing how common this is. It is also possible that they may lead to a slightly higher chance of miscarriage, but this is also unknown. Most gynecologists will remove polyps if they are found in women with a history of miscarriage.
If a polyp is diagnosed one of the first questions is, "Could this be cancer?" Although some polyps are thought to turn gradually into cancer, fortunately they rarely do. The risk does increase slightly as a patient passes age 50: polyps that appear during menopause may put the woman at greater risk. Usually, postmenopausal bleeding caused by the polyps will warn women to seek care.