None

Endometrial polyps are relatively common intrauterine lesions that are typically benign and often asymptomatic. Hyperplastic/proliferative polyp is the most common type of polyp; it represents overgrowth of endometrial glands and stroma. Clinically they can be associated with postmenopausal and abnormal uterine bleeding as well as infertility.

The ultrasound appearance of endometrial polyps varies depending on whether the patient is premenopausal or postmenopausal. In premenopausal women, the endometrium (especially in the secretory/luteal phase) can be thick and heterogeneous, which often camouflages the polyps. In the proliferative/follicular phase or in postmenopausal women, when the endometrium is at its thinnest, the polyps may be more obvious because of their rounded contour and different echotexture from the surrounding endometrium. Polyps appear as hyperechoic or cystic lesions within the uterine cavity. In most cases, there is evidence of blood flow in the polyp, as seen by color flow Doppler. The stalk of the polyp can often be identified by Doppler, revealing a single-vessel pattern and thus highlighting the connection between the polyp and the underlying endometrium.

When the endometrium is thickened and heterogeneous and the patient is either postmenopausal or in the proliferative/follicular phase of her cycle, a sonohysterogram may be necessary to further define the finding. If there is a small mass within the cavity, the differential diagnosis is either a polyp or a submucosal fibroid. A polyp is usually more hyperechoic than the surrounding endometrium, or it may be partly cystic. A fibroid is likely to have the same echotexture as the myometrium. Rarely, an adenomyoma can present as an intracavitary mass (see Adenomyosis). It may be difficult to differentiate a nonglobal endometrial cancer, which appears polypoid, from a true polyp.

Postmenopausal patients with nonbleeding polyps are not automatic candidates for polypectomy. If it is removed, it should be done hysteroscopically, because blind D&C often misses such focal lesions. Patients with abnormal or postmenopausal bleeding are always candidates for removal of their polyps.