Uterine polyps are soft, fleshy growths that develop from the tissue lining the uterus, known as the endometrium. These growths, also called endometrial polyps, form when there is an overgrowth of cells in the inner uterine wall, attaching by a thin stalk or a broad base. They can vary in size from a few millimeters to several centimeters, sometimes extending into the cervical canal. The most common sign of their presence is abnormal uterine bleeding, which may include spotting between periods, heavy menstrual flow, or bleeding after menopause. Uterine polyps are overwhelmingly non-cancerous, but their estrogen-sensitive nature means they can cause symptoms and interfere with fertility. Management strategies range from attempts to reduce their size to definitive surgical removal.
Hormonal Therapies for Size Reduction
Hormonal treatments manage the symptoms of uterine polyps and can induce a temporary reduction in size. Since polyp growth is highly influenced by estrogen, medications are designed to counteract this proliferative effect or create a low-estrogen environment.
Progestins, synthetic forms of progesterone, are frequently prescribed to manage polyp-related bleeding. They can be delivered through oral tablets, injections, or a progestin-releasing intrauterine device (IUD). Progestin opposes estrogen’s effect on the endometrium, helping to stabilize the lining and diminish abnormal bleeding.
Gonadotropin-releasing hormone (GnRH) agonists temporarily create a low-estrogen state, similar to menopause. This hypoestrogenic state can cause polyps to shrink, especially larger ones, by removing the hormonal stimulus for growth. GnRH agonists are generally a short-term solution, sometimes used before surgery to reduce the size of a very large polyp, making subsequent removal less complex.
Any size reduction achieved with hormonal medications is often temporary. Once the drug is discontinued, the polyps’ growth stimulus returns, and symptoms frequently recur. These therapies are primarily viewed as a way to control symptoms or as a bridge to surgery, rather than a permanent solution.
Dietary and Complementary Management
Lifestyle adjustments and specific dietary choices can help manage the hormonal environment that encourages polyp growth. Uterine polyps are linked to conditions of excess estrogen, often resulting from an imbalance between estrogen and progesterone levels.
Maintaining a healthy body weight is one of the most effective non-pharmaceutical methods for influencing hormone balance. Fat tissue produces estrogen, meaning that increased body fat can lead to higher circulating estrogen levels. Adopting a diet rich in fiber, such as from whole grains and vegetables, also aids in the body’s natural process of excreting metabolized estrogen.
Some complementary approaches focus on enhancing the liver’s ability to process and eliminate estrogen. Supplements containing compounds like Diindolylmethane (DIM) or Indole-3-Carbinol (I3C), derived from cruciferous vegetables, are often used to support healthy estrogen metabolism pathways. Flaxseed is another common recommendation due to its lignans, compounds that can bind to estrogen and aid in its removal.
These strategies are considered supportive and preventive, aiming to reduce the risk of recurrence or new growth. There is limited clinical evidence that lifestyle changes alone can cause the complete elimination or shrinkage of existing polyps. They work best when integrated with professional medical oversight.
When Definitive Removal is Required
While managing polyp size and symptoms with medication or lifestyle changes is sometimes possible, definitive removal is often the recommended course, especially for symptomatic, large, or suspicious growths. Hysteroscopic polypectomy is considered the standard of care for permanently addressing uterine polyps.
The procedure involves the surgeon inserting a thin, lighted telescope, called a hysteroscope, through the vagina and cervix into the uterine cavity. This provides a clear, magnified view of the polyp, which is then carefully excised at its base using specialized instruments passed through the hysteroscope. The ability to directly visualize the polyp ensures that the entire growth is removed, which significantly reduces the chance of recurrence.
Removal is typically recommended when polyps cause persistent, bothersome symptoms, such as heavy or irregular bleeding that interferes with daily life. It is also often advised when a patient is experiencing infertility, as polyps can interfere with embryo implantation. Furthermore, removal is standard for polyps detected after menopause or those that are large—generally over one centimeter—due to a slightly increased risk of precancerous or cancerous changes.
The success rate for symptom resolution after hysteroscopic polypectomy is high, often ranging between 75% and 100% for abnormal bleeding. Since the procedure avoids an abdominal incision, recovery is typically fast, with most patients resuming normal activity within a day or two. The removed tissue is always sent to a pathology lab for analysis to confirm the benign nature of the growth.