Uterine Polyp Removal (Polypectomy)

Introduction

If you have been told that you have a uterine polyp and that it should be removed, this article is for you. A uterine polyp is a small growth that develops from the lining of the uterus (the womb). Most polyps are not cancer, but they can cause symptoms such as irregular bleeding, heavy periods, bleeding after menopause, or difficulty becoming pregnant. They are also sometimes found by chance during an ultrasound done for another reason.

The procedure to remove a uterine polyp is called a polypectomy. In modern gynaecology, it is almost always done using a thin telescope called a hysteroscope, which is passed through the vagina and cervix into the uterus. There are no cuts on the abdomen, the procedure usually takes less than an hour, and most patients go home the same day.

This guide explains what uterine polyps are, why removal is recommended in certain situations, how the procedure is done, and what recovery looks like. It is written for patients who already know they have a polyp and are now preparing for treatment.

What Is Uterine Polyp Removal (Polypectomy)?

Uterine polyps — also called endometrial polyps — are soft, finger-like or rounded growths that form from the inner lining of the uterus, which is called the endometrium. They are usually attached to the uterine wall by a thin stalk or a broader base. Polyps can be as small as a few millimetres or as large as several centimetres. There may be a single polyp or several at the same time.

A polypectomy is the surgical removal of one or more of these growths. The aim is to take out the entire polyp, including its base, so that it does not grow back, and to send the tissue to a laboratory for examination under a microscope. This examination confirms that the polyp is benign (non-cancerous) and rules out any pre-cancerous or cancerous changes.

The procedure is sometimes called:

• Hysteroscopic polypectomy — the modern standard, where a hysteroscope is used to see the polyp and remove it under direct vision
• Endometrial polypectomy — another name for the same operation
• Dilatation and curettage (D&C) with polypectomy — an older technique where the cervix is opened and the lining of the uterus is scraped; this is now used less often because polyps can be missed without direct vision

Uterine polyps are different from uterine fibroids, which are firm growths of muscle tissue that develop in the wall of the uterus. Fibroids are managed differently and are not removed by the same hysteroscopic technique used for polyps unless they happen to bulge into the cavity of the uterus (submucosal fibroids).

Why Is Polypectomy Performed?

Doctors recommend removing a uterine polyp in several situations. Whether removal is suggested depends on the symptoms, the size and number of polyps, the patient’s age, and whether they are trying to conceive.

Abnormal Uterine Bleeding

The most common reason for polypectomy is abnormal bleeding. This may include:

• Heavier periods than usual
• Bleeding or spotting between periods
• Irregular menstrual cycles
• Bleeding after sexual intercourse
• Any bleeding after menopause

Bleeding happens because the polyp’s surface is fragile and can shed or bleed at times other than during a normal period. Removing the polyp often resolves these symptoms.

Bleeding After Menopause

Any vaginal bleeding after menopause is taken seriously. Even when most polyps in this age group are benign, the chance of a polyp containing pre-cancerous or cancerous tissue is higher than before menopause. Major societies, including ACOG and the AAGL (American Association of Gynecologic Laparoscopists), recommend that polyps found in post-menopausal women, especially when they cause bleeding, should be removed and examined.

Fertility Concerns

Polyps inside the uterine cavity can interfere with conception or with the implantation of an embryo. They may also affect the success of fertility treatments such as IVF (in vitro fertilisation). For patients who are trying to conceive or are about to start fertility treatment, doctors often recommend removing polyps before proceeding, as several studies suggest that this can improve pregnancy rates.

Polyps Found by Chance

Sometimes a polyp is discovered during an ultrasound or hysteroscopy done for another reason, in a patient who has no symptoms. In this situation, the decision about whether to remove the polyp depends on its size, the patient’s age, whether they have gone through menopause, and any risk factors for endometrial cancer (such as obesity, diabetes, tamoxifen use, or a family history). Small, symptomless polyps in younger women are sometimes simply monitored, as a proportion of them resolve on their own.

Risk of Malignancy

The overall risk that a uterine polyp contains cancer is low — commonly cited as well under 5% across all patients, and higher in post-menopausal women, especially those with bleeding. Because the risk is not zero, removal allows the polyp to be examined microscopically, which provides reassurance or, occasionally, early detection of disease.

Who Is a Candidate?

Most patients with a confirmed uterine polyp can have a hysteroscopic polypectomy. The procedure suits patients across a wide age range, including those who have not yet had children, those who want to preserve their fertility, and post-menopausal women.

Your doctor will consider the following before scheduling the procedure:

• Confirmation of the polyp — usually by transvaginal ultrasound, saline-infusion sonography (an ultrasound done with a small amount of fluid placed in the uterus to outline the polyp), or diagnostic hysteroscopy
• Size and location — very large polyps, or polyps with a broad base, may need a slightly different surgical plan
• Number of polyps — multiple polyps may take longer to remove
• General health — conditions that affect anaesthesia, such as heart or lung disease, are taken into account
• Active infection — pelvic infection should be treated before the procedure
• Pregnancy — polypectomy is not done during pregnancy

Patients on blood-thinning medications may need to pause them for a short period before surgery, under their doctor’s guidance.

Alternatives to Polypectomy

Polyp removal is the definitive treatment, but it is not the only option in every case. The alternatives depend on the clinical situation.

Watchful Waiting

For small polyps (often quoted as less than around 1 cm) in pre-menopausal women without symptoms, doctors may suggest simply monitoring. Studies show that a portion of small polyps regress on their own over months. If symptoms develop or the polyp grows, removal can be revisited.

Medical Therapy

Hormonal treatments such as combined oral contraceptive pills or progestin-containing therapies are sometimes used to manage abnormal bleeding. These do not reliably remove polyps, but they can control symptoms in some patients. Medications cannot replace tissue diagnosis when there is concern about pre-cancerous change.

Dilatation and Curettage (D&C) Without Hysteroscopy

This older procedure scrapes the lining of the uterus blindly, without direct vision. It has largely been replaced by hysteroscopic polypectomy because polyps can be missed or only partially removed when the operator cannot see them. Where hysteroscopy is not available, D&C is still used as an alternative.

Hysterectomy

Hysterectomy — removal of the uterus — is a much larger operation and is not used for benign polyps in routine practice. It may be considered if polyps are found alongside other conditions that already justify hysterectomy, or if the tissue examination reveals a cancer that requires more extensive surgery.

Endometrial Ablation

This procedure destroys the lining of the uterus to control heavy bleeding. It is not used as a primary treatment for polyps because it does not allow tissue to be sent for examination, and it ends the possibility of future pregnancy. It is sometimes combined with polypectomy in patients who do not want children and have heavy bleeding.

Surgical Approaches

Almost all uterine polyps today are removed by hysteroscopic polypectomy. Within this approach, there are a few different techniques.

Hysteroscopic Polypectomy with Scissors or Graspers

A small hysteroscope is passed through the cervix into the uterus. Sterile fluid is gently flowed into the uterus to expand the cavity and allow a clear view. The surgeon then uses tiny scissors, graspers, or biopsy forceps passed down a channel in the hysteroscope to cut and remove the polyp. This technique is well suited to small or stalked polyps and can sometimes be done in an outpatient setting without general anaesthesia.

Hysteroscopic Resection with an Electrical Loop (Resectoscope)

A larger hysteroscope called a resectoscope is used. It carries a fine wire loop heated by electrical current, which shaves the polyp off in slices. This technique is often chosen for larger polyps or those with a broad base, and is usually done in an operating theatre under general or regional anaesthesia.

Hysteroscopic Tissue Removal Systems (Morcellators)

These are newer devices that combine cutting and suction in a single instrument. The polyp is shaved away and immediately suctioned out for examination. Tissue removal systems are quicker for larger polyps and avoid the use of electrical current inside the uterus. Their availability varies between hospitals.

Dilatation and Curettage (D&C)

As mentioned earlier, blind curettage is now used less often. It involves dilating the cervix and scraping the uterine lining with a sharp or suction curette. Current guidance from major societies favours hysteroscopic removal over blind D&C because direct vision allows the entire polyp, including its base, to be taken out.

Laparotomy or Laparoscopy

Abdominal surgery is not used for ordinary uterine polyps. It is reserved for very rare situations, such as when a polyp turns out to be cancer that has spread beyond the uterine cavity.

Preparing for Polypectomy

Once a polypectomy is scheduled, your team will give you instructions tailored to your situation. The following items are common.

Tests Before Surgery

You may have:

• A repeat ultrasound or saline-infusion sonography to confirm the location and size of the polyp
• Routine blood tests, including a haemoglobin level if you have been bleeding heavily
• An assessment for anaesthesia, if general or regional anaesthesia is planned
• A pregnancy test for patients of reproductive age

Medications

Tell your doctor about every medication and supplement you take. Some blood thinners and herbal supplements increase bleeding risk and may need to be stopped a few days before the procedure. Your usual medications for blood pressure, thyroid, or other conditions are usually continued, but always confirm with the team.

Cervical Preparation

In some patients — especially post-menopausal women or those who have not given birth vaginally — the cervix can be tight and difficult to dilate. The doctor may prescribe a medication (commonly misoprostol) to soften the cervix the night before or a few hours before the procedure.

Timing in the Menstrual Cycle

For patients who are still menstruating, the procedure is often scheduled in the first half of the cycle, soon after a period ends. At this time the uterine lining is thin and polyps are easier to see.

The Day Before and the Day Of

• Follow fasting instructions carefully — usually no food for about six hours and clear fluids only for a shorter window before anaesthesia
• Arrange for someone to bring you home, as you should not drive after sedation or anaesthesia
• Wear comfortable clothes and bring sanitary pads, as some bleeding is expected afterwards
• Remove jewellery, nail polish, and contact lenses if asked

What Happens During the Procedure

A hysteroscopic polypectomy typically takes 15 to 45 minutes, although check-in, preparation, and recovery extend the total hospital visit to several hours.

Anaesthesia

Depending on the setting, polypectomy may be done under:

• No anaesthesia or local anaesthesia — possible for small polyps in an outpatient hysteroscopy clinic, sometimes with a paracervical block
• Sedation — medications given through a vein to make you drowsy and pain-free
• Regional anaesthesia — a spinal injection that numbs the lower body
• General anaesthesia — you are fully asleep; commonly used for larger polyps or in the operating theatre

Position and Setup

You lie on the back with the legs supported, similar to a routine pelvic examination. The vaginal area is cleaned with antiseptic solution. A speculum is placed to see the cervix, which is then gently held with a special instrument and dilated slightly if needed.

The Hysteroscopy

The hysteroscope is passed through the cervix into the uterus. Sterile fluid (usually saline) flows in gently to expand the cavity, giving the surgeon a clear view on a video monitor. The polyp or polyps are inspected, and any other findings in the uterus are noted.

Removing the Polyp

The surgeon then uses scissors, graspers, an electrical loop, or a tissue removal device to detach the polyp at its base. Larger polyps may be cut into pieces for removal. The team aims to take out the entire polyp, including its attachment to the uterine wall, to reduce the chance of regrowth.

Tissue Examination

All removed tissue is sent to a pathology laboratory. The microscopic examination confirms whether the polyp is benign, pre-cancerous (hyperplasia), or cancerous. Results typically take a few days to a couple of weeks.

End of the Procedure

Once the polyp is removed and any minor bleeding is controlled, the instruments are withdrawn. You are moved to a recovery area where nurses monitor you until the effects of anaesthesia wear off.

Recovery and Healing

Hysteroscopic polypectomy is a minor procedure and recovery is generally quick.

The First Day

After the procedure you may feel:

• Mild cramping similar to period pain, usually relieved by simple painkillers such as paracetamol or ibuprofen
• Light to moderate vaginal bleeding or pink-brown discharge
• Drowsiness from anaesthesia for several hours
• Shoulder-tip ache occasionally, from the fluid used during the procedure

Most patients go home the same day, often within a few hours.

The First Week

It is generally advised to:

• Use sanitary pads rather than tampons or menstrual cups until bleeding stops
• Avoid vaginal intercourse, swimming, and tub baths for about one to two weeks, or as your doctor instructs
• Avoid heavy lifting and intense exercise for several days
• Take all medications, including any antibiotics, as prescribed

Your Next Period

The first period after polypectomy may come slightly earlier or later than expected and can be heavier or lighter than usual. By the second or third cycle, periods generally return to your individual normal pattern. For many patients, periods become lighter and more regular than before the procedure.

Follow-Up

A follow-up appointment is usually scheduled within a few weeks to review the pathology report and check on symptoms. Further investigation or treatment is planned only if needed — for example, if the pathology shows hyperplasia or cancer, or if symptoms persist.

Risks and Complications

Hysteroscopic polypectomy is considered a safe procedure with a low overall complication rate. As with any surgery, certain risks exist, and your team will discuss them as part of the consent process.

Common but Minor

• Cramping and discomfort for a day or two
• Light bleeding or discharge for one to two weeks
• Temporary changes in the next one or two menstrual cycles

Less Common

• Infection — mild infections of the uterus or pelvis can occur and are treated with antibiotics. Fever, foul-smelling discharge, or worsening pain should be reported to your team.
• Heavier bleeding than expected — usually settles, but rarely requires medical treatment
• Reaction to anaesthesia — uncommon, and managed by the anaesthesia team

Rare

• Uterine perforation — a small hole made in the wall of the uterus by an instrument. Most perforations heal on their own with observation; rarely, further surgery is needed.
• Cervical injury — tearing of the cervix during dilation, usually minor and treated with a stitch if necessary
• Fluid overload — absorption of too much of the distension fluid used during hysteroscopy. The team measures fluid use carefully to prevent this.
• Intrauterine adhesions (Asherman’s syndrome) — scar tissue inside the uterus. This is uncommon after a simple polypectomy but slightly more likely after extensive surgery.
• Incomplete removal — a small piece of polyp may remain, particularly with broad-based polyps, and a second procedure may be needed

Recurrence

Polyps can sometimes return after removal. The chance of recurrence depends on whether the entire base was removed, hormonal factors, and other conditions such as obesity or tamoxifen use. If symptoms return, your doctor may arrange another ultrasound or hysteroscopy.

Life After Polypectomy

For most patients, polypectomy is a one-off event with a quick return to normal life. The longer-term picture depends on why the polyp was removed and what the pathology shows.

If the Polyp Was Benign

Most polyps are benign. In this case, no further treatment is usually needed. Symptoms such as heavy or irregular bleeding often improve significantly. Your doctor will agree a follow-up plan based on your situation, which may simply mean reporting any new abnormal bleeding.

If You Are Trying to Conceive

If the polyp was removed to help with fertility, doctors typically suggest waiting one or two menstrual cycles before trying to conceive or proceeding with fertility treatment, to allow the uterine lining to heal. Studies suggest that pregnancy rates may improve after polyp removal in patients who were previously struggling to conceive.

If Pre-Cancerous or Cancerous Changes Were Found

Occasionally, pathology reveals endometrial hyperplasia (a thickened lining with abnormal cells) or, more rarely, endometrial cancer. In these situations your gynaecologist will discuss further treatment, which may include hormonal therapy, repeat sampling, or referral to a gynaecological cancer specialist. This is an uncommon outcome but an important reason why all polyps are sent for examination.

Preventing Recurrence

There is no guaranteed way to prevent polyps from coming back, but the following may help:

• Maintaining a healthy weight, since higher body weight is linked with higher estrogen levels and a higher risk of endometrial polyps
• Managing conditions such as high blood pressure and diabetes
• Discussing any hormone therapy or tamoxifen use with your doctor
• Reporting any new abnormal bleeding promptly

Frequently Asked Questions

Is polypectomy painful?

The procedure itself is not painful because of anaesthesia or sedation. Afterwards, most patients describe mild to moderate period-like cramps for a day or two, which respond well to simple painkillers.

Will I need to stay in hospital overnight?

Most hysteroscopic polypectomies are done as day cases. You arrive in the morning, have the procedure, and go home the same day after a few hours of monitoring.

How soon can I return to work?

Many patients with desk-based work return within one to three days. Jobs that involve heavy lifting or long hours on the feet may need a slightly longer break. Your team will give individual advice.

When can I have sex again?

Doctors usually advise avoiding vaginal intercourse for one to two weeks, until the bleeding has stopped and the cervix has closed, to reduce the risk of infection.

Will polypectomy affect my fertility?

A standard hysteroscopic polypectomy is not expected to harm fertility. In fact, removing polyps can improve the chances of conceiving for patients in whom polyps were affecting implantation. Very rarely, scar tissue forms inside the uterus after the procedure, which can affect fertility; this risk is low with simple polypectomy.

Can polyps come back?

Yes, polyps can recur in a minority of patients. Risk factors include incomplete removal, hormone therapy, tamoxifen use, and certain health conditions. If symptoms return, further imaging or hysteroscopy may be arranged.

What if the polyp is found to be cancerous?

This is uncommon, particularly in younger women, but it is one of the reasons every polyp is sent for examination. If cancer is found, your doctor will explain the next steps, which usually involve referral to a gynaecological cancer specialist for further assessment and treatment planning.

Is there any non-surgical way to remove a polyp?

There is no medication that reliably dissolves uterine polyps. Hormonal treatments can help control bleeding symptoms but do not remove the polyp tissue, which is why surgical removal remains the standard approach when treatment is needed.

How long do the pathology results take?

Results typically take a few days to two weeks, depending on the laboratory. Your team will share the results at your follow-up appointment or, if needed, sooner by phone.

Will I have a scar?

No. Hysteroscopic polypectomy is done entirely through the vagina and cervix. There are no cuts on the abdomen and no visible scars.

Conclusion

Uterine polyp removal is one of the most common minor gynaecological procedures and, for many patients, brings clear relief from bleeding symptoms or a step forward in fertility care. The modern approach — hysteroscopic polypectomy — allows the surgeon to see the polyp directly, remove it precisely, and send it for examination, all without any cut on the abdomen.

If you are preparing for polypectomy, knowing what to expect can make the experience easier: a short procedure, a few days of light recovery, and a follow-up to discuss the pathology result. The specifics of your own care — the type of anaesthesia, the technique used, and the follow-up plan — will be tailored to your situation by your gynaecologist, based on the size and number of polyps, your symptoms, your age, and your reproductive plans.