Uterine polyps are almost always removed through a procedure called hysteroscopic polypectomy, a minimally invasive surgery that takes place through the vagina with no external incisions. The entire process typically lasts under 30 minutes, and most people go home the same day. Here’s what the procedure involves from preparation through recovery.
How the Procedure Works, Step by Step
The surgery uses a hysteroscope, a thin tube with a small camera and light on the end. Your surgeon inserts it through your vagina and cervix into your uterus. Before insertion, the cervix is gently dilated (widened) to make room for the instrument.
Once the hysteroscope is in place, a liquid solution flows through it to expand your uterine cavity and clear away any blood or mucus. This gives the surgeon a clear view of the uterine lining and the openings of your fallopian tubes on a video monitor. The surgeon inspects the cavity, locates the polyp, and then passes a small cutting instrument through the hysteroscope to remove it. The removed tissue is sent to a lab to check for any abnormal cells.
The whole process is done through the natural opening of the cervix. There are no stitches on the outside, no abdominal cuts, and no scars.
Tools Used for Removal
Surgeons have a few options for the actual cutting, depending on the size and location of the polyp. Traditional approaches use a resectoscope (which cuts with electrical current), cold scissors, or small grasping forceps threaded through the hysteroscope.
Newer morcellator systems can simultaneously cut and suction out polyp tissue through a single working channel. These devices shave the polyp down while extracting the fragments in real time, which can make the procedure faster and reduce the number of times instruments need to go in and out. Your surgeon will choose the tool based on the polyp’s characteristics and what equipment is available.
Anesthesia and What You’ll Feel
Hysteroscopic polypectomy can be performed in an office setting or in an operating room, and the anesthesia approach differs between the two. Small polyps discovered during a diagnostic hysteroscopy can sometimes be removed right in the office with no advance preparation and only local numbing of the cervix. You may feel pressure or cramping, but the procedure is brief.
For larger polyps or operating room procedures, you’ll typically receive general anesthesia or conscious sedation, meaning you’ll either be fully asleep or deeply relaxed and unlikely to remember the procedure. The choice depends on the complexity of the removal, your medical history, and your comfort level.
How to Prepare
Preparation depends on where the procedure takes place. An in-office hysteroscopy generally requires no advance preparation at all. If your polypectomy is scheduled in an operating room, the typical instructions include:
- Fasting: Stop eating and drinking at midnight the night before surgery.
- Smoking: Avoid smoking for at least 24 hours beforehand, longer if possible.
- Medications: Stop or adjust any blood-thinning medications based on your surgeon’s specific instructions. This reduces the risk of excess bleeding during the procedure.
The procedure is usually scheduled for the first half of your menstrual cycle (after your period ends but before ovulation), when the uterine lining is thinnest and easiest to visualize.
Recovery and Getting Back to Normal
Most people go home within a few hours of the procedure. You can expect mild cramping similar to period pain and light spotting or bleeding for several days afterward. Over-the-counter pain relief is usually enough to manage discomfort.
The healing period typically takes two to three weeks. During that window, you should avoid sexual intercourse, tampons, and swimming to give the area time to heal and prevent infection. Vigorous exercise should also wait until after this recovery period. Light daily activities like walking are fine almost immediately.
After two to three weeks, a follow-up appointment confirms that healing is on track. Once your doctor gives the go-ahead, you can resume all normal activities, including exercise and intercourse.
Risks to Be Aware Of
Hysteroscopic polypectomy is considered low-risk, but no procedure is without potential complications. The main ones include infection, uterine perforation (when an instrument accidentally goes through the uterine wall), and fluid overload from the liquid solution used to expand the uterus. Fluid overload is rare but can be serious, particularly for people with kidney or heart conditions. Perforation is also uncommon and, when it does occur, often heals on its own without further surgery.
Some light bleeding after the procedure is normal. Heavy bleeding, fever, or severe pain that doesn’t respond to over-the-counter medication are signs something may need attention.
Do Polyps Come Back?
Polyps recur in roughly 8% of cases, with a median recurrence time of about 42 months (around three and a half years). That means the vast majority of people who have a polypectomy won’t see the polyp return, but periodic monitoring is still standard.
Follow-up typically involves a transvaginal ultrasound at six months after the procedure, then annually for patients with no symptoms. If abnormal bleeding returns or an ultrasound shows a thickened lining or new focal growth, your doctor will recommend another hysteroscopy to evaluate the area. Catching a recurrence early keeps management straightforward, since the same minimally invasive procedure can be repeated.