Decoding Uterine Polyps vs. Fibroids: Two Growths, Two Stories
- Preeti Prangya Panda
- Jun 18
- 5 min read
Fluctuations in estrogen and progesterone can lead to two problems known as polyps and fibroids in the uterus. Though the majority of them are harmless, noticing the differences allows you to get the proper care when needed.
In about 20 to 40 percent of cases, women experience abnormal bleeding in endometrial polyps. In contrast, about 25 to 30 percent of women experience bleeding from uterine fibroids.[1] |
Uterine fibroids, also referred to as uterine leiomyomata, are very common benign smooth‑muscle tumors that develop under estrogen stimulation in women of reproductive age.
Although many are asymptomatic and frequently found through imaging techniques, about one‑quarter to one‑third of patients suffer from abnormal bleeding, pelvic pain or pressure, anemia, and bladder or bowel dysfunction, which impair daily fitness.[2]
Endometrial polyps are caused by localized extra growth of endometrial glands in uterine tissue. These growths can be single or multiple and can range from a few millimeters to several centimeters, occur across all ages, but peak between 40 – 49 years.
They are generally benign, yet carry a small risk of malignant transformation. Because about 0 to 3 percent show malignant change, every polyp should be removed and examined histopathologically to rule out cancer. [1],[3]
Although less invasive options such as hormonal agents, tranexamic acid, nonsteroidal anti-inflammatory drugs (NSAIDs), gonadotropin-releasing hormone (GnRH) analogs, myomectomy, or uterine‑artery embolization exist, complexity increases when fibroids coexist with endometrial polyps—a combination that has not been systematically studied. [2]
Understanding how often these two pathologies overlap is essential because cancerous polyps are problematic, and treating polyps alone rarely resolves bleeding if multiple large fibroids remain.
At‑a‑Glance Comparison
Feature | Uterine Polyps | Uterine Fibroids |
Tissue of origin | Overgrowth of the endometrium (inner uterine lining) | Overgrowth of the uterus’s smooth‑muscle wall |
Typical size trend | Stay small (often < 2 cm) and may shrink on their own | Can enlarge markedly, stretching the uterus |
Cancer potential | Small but real risk of malignant change | Very rarely become cancerous |
Hormonal driver | Sensitive to estrogen fluctuations | Strongly estrogen‑responsive |
Who’s most affected | More common after menopause, but can appear sooner | Most often found in women > 30 years |
Typical symptoms | Irregular or heavy bleeding, spotting after menopause, and infertility | Heavy/prolonged periods, pelvic pressure, infertility, recurrent miscarriage |
First‑line treatment | Observation or hysteroscopic removal; hormonal meds for symptoms | Hormonal therapy, embolization, radio‑frequency removal, myomectomy, or hysterectomy if needed |
Uterine Fibroids in Detail
Fibroids are non‑cancerous tumors that originate inside the muscular wall of the uterus and can bulge inward or outward. Because fibroids over‑express estrogen and progesterone receptors, they enlarge with ovarian‑steroid exposure and typically shrink after pregnancy or after menopause when hormone levels drop.
Uterine fibroid formation is thought to arise from a mix of reproductive‑hormone influences, internal myometrial abnormalities, and genetic variants that disrupt cell‑signaling pathways.
The most frequent genetic driver is a MED12 mutation (present in ~70 % of cases).
Other mutations in HMGA1/2, COL4A4/6, or fumarate hydratase contribute to sporadic or hereditary forms. [3]
Black women face about a three‑times higher risk of developing uterine fibroids than White women, with lifetime incidence reaching roughly 80 % versus 50 – 70 %. They tend to develop fibroids earlier, with larger uteri and a higher rate of blood‑loss anemia. |
Possible effects
Heavy or long periods
Pelvic pain or pressure
Visible abdominal distention
Repeated pregnancy loss or infertility
Anemia, fatigue, and mood changes from chronic bleeding. [4]
Management options
Medication: combined hormonal contraceptives, progestin‑only devices or pills, GnRH agonists, NSAIDs for pain
Minimally invasive: uterine‑artery embolization, radio‑frequency ablation
Surgical: myomectomy (fibroid removal) preserves the uterus; hysterectomy (entire uterus) is irreversible. [2]
Endometrial Polyps in Detail
Endometrial polyps are localized overgrowths of endometrial glands and stroma whose exact cause is unclear, though unopposed estrogen, increased aromatase activity, growth factors (TGF‑β, VEGF), anti‑apoptotic signals (BCL‑2), genetic factors, and chronic tamoxifen use all contribute to their development.
Most polyps are benign, but malignant transformation occurs in up to about 13%, with risk rising in women over 60, those who are post‑menopausal, especially if symptomatic, and in polyps that are large or associated with conditions such as polycystic ovary syndrome. [1]
Among post‑menopausal women, the prevalence of cancer in symptomatic polyps is roughly 4.5%, versus 1.5% in those without symptoms. |
Possible effects
Unpredictable cycle length or flow
Spotting between periods
Post‑menopausal bleeding
Difficulty conceiving
Management options
Polyps are typically identified using transvaginal sonography, saline infusion sonohysterography, or hysteroscopy. [3]
Watchful waiting for very small, symptom‑free lesions
Hormonal therapy (progestins, GnRH agonists) to temper growth
Hysteroscopic polypectomy — a quick, targeted outpatient procedure that removes polyps and allows lab testing to rule out precancerous change
Case study A 59‑year‑old Nepali woman developed a rare “giant” endometrial polyp with a fibroid after her recommended weekly dose of phytoestrogen foods. It was confirmed during total abdominal hysterectomy with bilateral salpingo‑oophorectomy. This case shows that although most giant polyps have been linked to taking tamoxifen or raloxifene, in this case, the polyps developed as a result of older age and increased phytoestrogen intake from diet, which could mean phytoestrogens might stimulate the endometrial tissue. Since the role of phytoestrogens in leading to giant endometrial polyps is not well known, doctors should assess what their patients eat, and research should be done to better understand this association.[6] |
Why Distinguishing One from the Other Matters
Symptom overlap (heavy or irregular bleeding, fertility issues) means imaging or hysteroscopy is often needed for certainty.
Cancer risk diverges. Polyps rarely—but sometimes—harbor malignancy; fibroids rarely. Timely removal of suspicious polyps prevents trouble down the road.
Treatment paths differ. Medications that shrink fibroids may not eradicate polyps, and vice versa.
When to See a Specialist
Seek evaluation if you experience any of the following:
Menstrual flow is so heavy that it soaks sanitary pads hourly, or causes anemia
Bleeding between periods or after menopause
Pelvic pain, pressure, or a noticeably enlarged abdomen
Recurrent miscarriages or difficulty getting pregnant
A gynecologist can perform an ultrasound, hysteroscopy, or magnetic resonance imaging (MRI) to pinpoint the diagnosis and craft a personalized plan.
Takeaway
While both conditions are common, are influenced by hormones, and are usually benign, they should be treated differently due to their differences.
If you follow up on check‑ups and address bleeding as needed, any growth will have little effect on your health.
References
Mansour T, Chowdhury YS. Endometrial Polyp. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 May 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557824/.
Barjon K, Kahn J, Singh M. Uterine Leiomyomata. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 May 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK546680/.
Kaveh M, Sadegi K, Salarzaei M, Parooei F. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography, and hysteroscopy in evaluating the endometrial polyps in women with abnormal uterine bleeding: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne [Internet]. 2020 [cited 2025 May 19]; 15(3):403–15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457193/.
Navarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the Impact of Uterine Fibroids on Human Endometrium Function. Front Cell Dev Biol [Internet]. 2021 [cited 2025 May 19]; 9:633180. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186666/.
Patel DJ, Chaudhari K, Acharya N, Shrivastava D, Dave A, Patel A. Navigating Pregnancy With Uterine Fibroids: A Case Study. Cureus [Internet]. [cited 2025 May 19]; 16(7):e64793. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330289/.
Pokhrel KM, Pokhrel P, Mulmi U, Khanal K, Panthi A, Aryal S, et al. Giant endometrial polyp in a post-menopausal woman: a rare case report from Nepal. Ann Med Surg (Lond) [Internet]. 2024 [cited 2025 May 19]; 86(2):1215–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10849297/.
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