Endometrial polyp

What is endometrialpolyp?

An endometrial polyp is a localised overgrowth of the endometrium, the tissue lining the inside of the uterus. Polyps form when a small area of endometrial glands and stroma proliferates excessively, creating a soft, finger-like or rounded projection into the uterine cavity. They can be single or multiple, small or large enough to fill the entire cavity.

The vast majority of endometrial polyps are benign. However, a small proportion, estimated at 0.5 to 3% in premenopausal women and higher in postmenopausal women, contain atypical or malignant cells. Postmenopausal bleeding in the context of an endometrial polyp always warrants histological assessment.

Endometrial polyps are distinct from uterine fibroids. Fibroids are smooth muscle tumours arising from the uterine wall. Polyps arise from the endometrial lining and project into the cavity. MRI reliably distinguishes between the two.

Many endometrial polyps cause no symptoms and are discovered incidentally on pelvic imaging. When symptoms occur, they include:

• Irregular or unpredictable menstrual bleeding

• Heavier or longer periods than usual

• Bleeding or spotting between periods

• Postmenopausal bleeding, which always warrants investigation regardless of the cause

• Difficulty conceiving, particularly when polyps obstruct the fallopian tube openings or disrupt implantation

• Pelvic discomfort or a feeling of pressure in rare cases when polyps are large

Endometrial polyps develop through localised endometrial overgrowth driven by hormonal and genetic factors. Contributing causes include:

• Oestrogen excess: the main trigger. Polyps grow in response to high oestrogen. Risks include PCOS, obesity, and the transition to menopause.

• Age: most common in women in their 40s and 50s. Risk of the polyp being cancerous increases after menopause.

• Tamoxifen use: this breast cancer medication can act like oestrogen in the uterus, significantly raising the risk of polyps.

• Obesity: excess adipose tissue increases circulating oestrogen through peripheral aromatisation, promoting endometrial proliferation.

• Hypertension: high blood pressure is linked to a higher chance of developing polyps, though the exact reason is still being studied.

• Hormone replacement therapy: particularly oestrogen-only HRT, increases polyp risk in postmenopausal women.

• Genetic factors: some polyps show specific gene changes, suggesting they may start from a single mutated cell.

Endometrial polyps are detected primarily through pelvic imaging, with bloods providing the hormonal and metabolic context.

Pelvic MRI Elfcare’s full-body MRI directly images the uterus to find polyps, assess their size, and distinguish them from other issues like fibroids. It also measures the thickness of the uterine lining, which is a key health marker after menopause. If a suspicious area is found, we coordinate follow-up hysteroscopy for direct visualization and sampling.

Blood tests assess the hormonal and metabolic environment most closely associated with endometrial polyp development. Relevant markers in Elfcare's panel include:

• Oestradiol and progesterone: checks for the hormonal imbalances that cause the uterine lining to overgrow.

• LH and FSH: determines your overall reproductive status and whether you are approaching menopause.

• TSH: screens for thyroid issues that can cause bleeding symptoms similar to polyps.

• HbA1c and glucose: assess insulin resistance, a known risk factor for uterine overgrowth.

• CRP: measures systemic inflammation that can influence the metabolic environment of the uterus.

• Haemoglobin and ferritin: checks for anemia caused by the heavy or irregular bleeding often associated with polyps.

Why early detection matters

Most endometrial polyps are benign, and some smaller polyps may resolve spontaneously in premenopausal women, though this is not the rule.. But postmenopausal polyps carry a meaningfully higher malignancy risk and always require histological assessment. In women trying to conceive, polyps occupying the uterine cavity reduce implantation rates and should be identified and removed before assisted reproduction is pursued. Identifying a polyp early, before it causes significant bleeding or fertility complications, allows for informed monitoring or timely removal under hysteroscopy, a straightforward minimally invasive procedure with excellent outcomes.

How Elfcare can help

Elfcare's pelvic MRI images the uterine cavity directly, identifying endometrial polyps, assessing endometrial thickness, and distinguishing polyps from other intracavitary pathology including submucosal fibroids and endometrial hyperplasia. For women with abnormal bleeding or fertility concerns, this structural assessment is the most clinically meaningful finding Elfcare can provide in this context.

Our blood panel covers oestradiol, progesterone, LH, FSH, TSH, HbA1c, and iron markers, providing the hormonal and metabolic context surrounding polyp development.

If our MRI or blood tests identify an endometrial polyp or related finding, we take care of further diagnostics or refer you to the appropriate specialist.