Cervical Polyp: Symptoms, Types, Causes and Treatment

Cervical polyps are common, mostly benign growths that can form on the cervix—the lower, narrow part of the uterus. While most women with cervical polyps have no symptoms and discover them during routine gynecological exams, some may experience discomforting symptoms that warrant medical attention. Understanding the symptoms, types, causes, and treatment options for cervical polyps is essential for informed reproductive and gynecological health. This comprehensive guide explains everything you need to know, based on the latest evidence.

Symptoms of Cervical Polyp

Cervical polyps often go unnoticed due to their asymptomatic nature. However, when symptoms do arise, they can significantly impact a woman's quality of life. Recognizing these symptoms is crucial for timely diagnosis and management.

Symptom	Description	Frequency/Significance	Source
Vaginal bleeding	Irregular, intermenstrual, or postcoital bleeding	Most common presenting symptom	1 4 5 6 11
Vaginal discharge	White or mucous-like discharge	Frequently reported	1 4 11
Postmenopausal bleeding	Bleeding after menopause	Particularly significant in older women	7 9 11
Asymptomatic	No noticeable symptoms	Up to 60% of cases	1 5 7 11

Table 1: Key Symptoms

Understanding the Symptoms

Common Presentations

• Intermenstrual Bleeding: Many women with cervical polyps report bleeding between periods. This can be light spotting or more substantial bleeding and is a classic symptom that prompts further investigation 1 4 5.
• Postcoital Bleeding: Bleeding after sexual intercourse is another hallmark sign, often leading women to seek medical attention 11.
• Vaginal Discharge: Some women notice an increase in white or mucous-like discharge, which may be mistaken for a mild infection 1 4 11.
• Postmenopausal Bleeding: This symptom is particularly concerning and warrants prompt evaluation, as it can indicate underlying pathology in older women 7 9 11.

Asymptomatic Cases

Interestingly, a large proportion of cervical polyps are found incidentally during routine pelvic exams, especially in asymptomatic women. Studies report that up to 60% of cases are discovered this way 1 5 7. While these polyps are often benign, their discovery still necessitates further evaluation to rule out rare but possible malignancy.

Less Common Symptoms

• Heavy Menstrual Bleeding (Metrorrhagia): Occasionally, especially with larger polyps, women may experience heavy or prolonged periods 6 11.
• No Symptoms at All: Many women are entirely unaware of their polyps and only learn of their presence during screening or investigation for unrelated issues 1 5 7.

Types of Cervical Polyp

Cervical polyps are not all the same. Their types are classified based on their origin, structure, and histological features. Knowing the different types helps guide management and predict potential outcomes.

Type	Origin/Structure	Key Characteristics	Source
Endocervical polyp	Endocervical canal	Most common; mucous, soft	4 5 11
Ectocervical polyp	Ectocervix (outer cervix)	Less common; often firmer	4 11
Fibroepithelial polyp	Stromal tissue	Late stage of polypoid process	4
Leiomyomatous polyp	Smooth muscle origin	Rare; firm, can be larger	4 5
Adenomatous polyp	Glandular tissue	Rare; potential for neoplasia	4
Nabothian cyst	Blocked glandular duct	Cyst-like, not true polyps	4

Table 2: Main Types of Cervical Polyps

Distinguishing the Types

Endocervical Polyps

• Most Prevalent: About half of all cervical polyps are endocervical in origin 4 5 11.
• Appearance: They are typically soft, smooth, and mucous-filled, arising from the inner lining of the cervical canal.
• Age: Most commonly seen in women aged 40–49 5.

Ectocervical Polyps

• Origin: These polyps arise from the outer part of the cervix and are less common.
• Texture: They tend to be firmer than endocervical types 4 11.

Fibroepithelial Polyps

• Developmental Sequence: Considered a late stage in the spectrum of polypoid cervical lesions, evolving from inflamed (endocervicitis) to fibroepithelial over time 4.
• Structure: Composed of stromal (connective) tissue, sometimes with squamous metaplasia.

Less Common Types

• Leiomyomatous Polyps: Originate from smooth muscle cells; rare but can present as larger, firm lesions 4 5.
• Adenomatous Polyps: Derived from glandular tissue and may have a slightly higher risk for neoplastic transformation 4.
• Nabothian Cysts: Though technically not true polyps, they are sometimes clinically mistaken for polyps due to their appearance 4.

Malignant and Atypical Polyps

• While the vast majority of cervical polyps are benign, rare cases may harbor dysplasia or malignancy. Studies show an incidence of malignant change ranging from 0.2% to 1.5% 1 3.
• Polypoid masses may also be the initial presentation of cervical or endometrial cancers, underscoring the need for histopathological assessment 3 4.

Causes of Cervical Polyp

Understanding why cervical polyps develop is crucial for prevention and management strategies. While the exact cause is often multifactorial, several contributing factors have been identified.

Cause	Mechanism/Description	Contribution/Prevalence	Source
Hormonal factors	Estrogen-induced hyperplasia	Significant etiologic role	1 8 10
Chronic inflammation	Local irritation/infection	Promotes polyp formation	4 6 10
Vascular congestion	Impaired blood flow in cervix	Supports polyp growth	6 10
Genetic/epigenetic	Chromosomal and metabolic changes	Hypothesized role	10
Age and reproductive status	Incidence increases with age and parity	Higher in peri/postmenopausal	4 5 8
Pregnancy	Polyps may enlarge during gestation	Hormonal influence	10

Table 3: Main Causes of Cervical Polyp

Delving into the Causes

Hormonal Influences

• Estrogen Excess: High levels of estrogen are believed to promote the hyperplasia (overgrowth) of the endocervical glandular epithelium, leading to polyp formation 1 8 10.
• Pregnancy: Polyps often grow larger during pregnancy due to elevated hormone levels 10.

Chronic Inflammation and Infection

• Local Irritation: Repeated or persistent inflammation of the cervix, sometimes due to infection or mechanical irritation (e.g., tampon use), is a known risk factor 4 6 10.
• Secondary Changes: Inflammatory processes can cause the mucosa to become more susceptible to polypoid growth.

Vascular Factors

• Congestion: Poor local blood flow or venous congestion in the cervix may contribute to the development and persistence of polyps 6 10.

Genetic and Epigenetic Factors

• Chromosomal Changes: Emerging research suggests that certain chromosomal modifications and enzyme/metabolic activity differences may predispose some women to polyp formation 10.

Age, Menopause, and Parity

• Incidence Rises with Age: Polyps are more frequently seen in women aged 20–50 and peak in the peri- and postmenopausal years 4 5 8.
• Parity: Women who have had children may have a higher risk, potentially due to cervical changes during childbirth.

Treatment of Cervical Polyp

Timely and appropriate treatment of cervical polyps is important to alleviate symptoms, prevent complications, and exclude malignancy. Most cases are managed easily and safely.

Treatment Option	Indications/Context	Key Features	Source
Polypectomy (removal)	Symptomatic or suspicious polyps	Outpatient or office procedure	3 5 6 7 11
Histopathological exam	All removed polyps	Excludes malignancy	1 3 6 11
Dilation & curettage (D&C)	Symptomatic/postmenopausal women	Used if endometrial disease suspected	1 7 9 10
Hysteroscopic removal	Difficult or large/uncertain origin	Direct visualization; precise	8 10 11
Expectant management	Small, asymptomatic, low-risk polyps	Regular follow-up, no intervention	5 7 9 10

Table 4: Treatment Options

Exploring Treatment Approaches

Polypectomy

• First-Line Therapy: The standard treatment for cervical polyps is simple removal—either by twisting, snipping, or using surgical instruments 3 5 6 7 11.
• Outpatient Setting: Most polyps can be removed safely in the office or outpatient clinic, often with minimal discomfort and quick recovery 7 11.

Histopathological Examination

• Mandatory Step: All excised polyps should be sent for microscopic (histological) examination to rule out atypical or malignant changes, even though the risk is low 1 3 6 11.
• Why It Matters: Rarely, a polyp may be the first sign of a more serious condition, such as carcinoma or dysplasia 3.

Dilation and Curettage (D&C)

• When Used: D&C is generally reserved for women with abnormal uterine bleeding, postmenopausal status, or suspicion of coexisting endometrial pathology 1 7 9 10.
• Current Trends: For asymptomatic premenopausal women, D&C is often unnecessary; instead, focus is placed on polypectomy alone 7 9.

Hysteroscopic Polypectomy

• Advantages: Hysteroscopy allows direct visualization of the cervix and uterine cavity, ensuring complete removal and assessment for other lesions 8 10 11.
• Particularly Useful: In cases where the polyp's origin is unclear or when large or multiple polyps are present.

Expectant (Conservative) Management

• Appropriate For: Small, asymptomatic polyps in low-risk women, especially if the chance of malignancy is minimal 5 7 9 10.
• Monitoring: Regular follow-up is recommended to observe for any changes.

Special Considerations

• Postmenopausal Women: Higher vigilance is required due to the increased risk of concurrent endometrial pathology. In this group, polypectomy should be followed by D&C or endometrial sampling 9 10.
• Recurrence: Most women do not experience recurrence after complete removal, but ongoing observation is prudent 10.

Conclusion

Cervical polyps are common, benign growths that are often asymptomatic but can present with a range of symptoms, particularly abnormal vaginal bleeding or discharge. Understanding their types, causes, and management options is key for optimal gynecological care. Here’s a summary of the most important takeaways:

• Symptoms: Most polyps cause no symptoms but can lead to intermenstrual or postcoital bleeding, vaginal discharge, or postmenopausal bleeding 1 4 5 6 7 9 11.
• Types: The majority are endocervical polyps, but other types like ectocervical, fibroepithelial, and leiomyomatous polyps exist 4 5 11.
• Causes: Hormonal influences, chronic inflammation, vascular congestion, genetic factors, and increased age all play roles in polyp development 1 4 5 6 8 10.
• Treatment: Simple polypectomy is usually effective, with histopathological examination to rule out malignancy; D&C or hysteroscopy may be indicated in selected cases 1 3 5 6 7 8 9 10 11.
• Follow-up: Asymptomatic, low-risk polyps may be monitored, but symptomatic or postmenopausal cases require more thorough evaluation 5 7 9 10.

Awareness, timely diagnosis, and appropriate management are essential for the effective care of women with cervical polyps.