What Are Cervical Polyps?

For a relatively tiny body part, the cervix has some big jobs. This muscular, canal-shaped organ connects the base of the uterus and the vagina. At just one to two inches long, it allows blood to be released during menstruation and opens wide enough for a baby to be delivered during a vaginal birth. As small and mighty as your cervix is, though, having a polyp grow inside it can create some health concerns.

About 2% to 5% of women develop cervical polyps (which are almost always benign) at some point in their lives, per the Cleveland Clinic. They are most common shortly after your reproductive years and in women who have had more than one child.

If your doctor has told you that you have a cervical polyp, you’ve got questions. We asked experts why polyps can occur and when and how they are removed.

“Cervical polyps are benign fleshy growths that occur right at the opening of the cervix, which is called the cervical os. It’s where the pap smear is done,” explains Carey York-Best, M.D., the division director of benign gynecology and obstetrics at Massachusetts General Hospital in Boston. These polyps are typically small, about one inch (3 centimeters) or less across, although they can also be larger. They can also vary in shape and color, appearing as round or tear-shaped and either cherry-red or greyish-white in color, per the National Library of Medicine.

Cervical polyps are broken down into two categories based on where they start, either endocervical or ectocervical.

Endocervical Polyps

“Most polyps are endocervical in origin,” says Dr. York-Best. “They come from the cervical canal, which is lined with glandular cells.” Endo-, the prefix, means inner or within, so these are polyps that grow from within the cervix. They typically occur in premenopausal women.

Ectocervical Polyps

Ecto-, as you may have guessed, means outer or external, so these are polyps that grow from the outer part of the cervix. “There is a transition point right at the cervical os where the glandular internal cells meet the smooth external cells,” explains Dr. York-Best. “Ectocervical polyps originate from the smooth squamous cells that cover the majority of the cervix.” They are more common in postmenopausal women, per the National Library of Medicine.

“Most women with cervical polyps are asymptomatic,” says Kecia Gaither, M.D., the director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in New York City. As such, you’ll only know that you have them if you’re having a pelvic exam for another reason, such as a routine pap smear.

If you do have symptoms, they may include:

• Abnormal vaginal bleeding, such as between periods

• Bleeding with intercourse

• Foul-smelling discharge

• Heavy menstrual bleeding

The exact cause of cervical polyps is not known, but there are a few factors that can contribute to their growth.

High Estrogen Levels

High levels of estrogen may be a factor in the development of polyps in postmenopausal women, explains Dr. York-Best. “Most healthy premenopausal women have normally high estrogen levels which are unlikely to affect cervical polyps. When they occur in a postmenopausal woman they may be associated with a higher level of estrogen,” she says. The reason: Estrogen plays a key role in the growth of cervical tissue (it prompts the lining of the cervix to thicken during the menstrual cycle, for example). If a post-menopausal woman has higher levels of circulating estrogen than normal, it may prompt abnormal growth of cervical tissue in the form of polyps.

Inflammation

“Polyps can be related to chronic inflammation of the cervical canal,” Dr. York-Best says. Inflammation of the cervix, or cervicitis, can be caused by sexually transmitted infections (STIs), bacterial vaginosis, or an irritation or allergic reaction to a foreign object or substance like an IUD, tampon, or condom. When inflammation exists—no matter where in the body—it prompts a reaction by the immune system to rebuild healthy cells in the area. But when inflammation is chronic, this reaction can become out of control, resulting in abnormal cell growth like polyps.

Infection

Infections—especially if they are chronic and left untreated—can sometimes be behind the inflammation causing polyps to grow in the cervix. However, a polyp itself isn’t the only sign of an STI, notes Dr York-Best; there are usually other symptoms that also occur such as painful urination or abnormal vaginal discharge, per the Mayo Clinic.

Clogged Blood Vessels Near the Cervix

According to the National Library of Medicine, one theory of why cervical polyps develop is that blood vessels near the cervix become clogged, disrupting blood flow to the area and leading to abnormal cell growth, in the form of polyps. However, notes Dr. York-Best, this is not a common occurrence and has not been confirmed in clinical studies.

Cervical polyps are diagnosed during a pelvic exam, says Dr. Gaither. Since they typically don’t cause any symptoms, they’ll likely only be noticed if you’re seeing an OB/GYN, midwife, or other women’s healthcare provider for an exam for another reason.

In most cases, if you don’t have any symptoms and the cervical polyps are small, you won’t need any treatment, says Dr. York-Best. “They are almost uniformly benign and we don’t remove them just to test them,” she notes. In fact, less than 1% of cases of cervical polyps are cancerous, according to the Cleveland Clinic. However, if you are experiencing symptoms like abnormal bleeding, or if there are other signs (like if an ultrasound reveals they are particularly large), your physician may decide that your polyps should be biopsied and removed.

There are two common procedures for removing cervical polyps, says Dr. Gaither, both of which are done through the vagina. They are:

• Polypectomy: The more utilized procedure, this strategy is also used for polyps in other organs, such as the colon, per Brigham and Women’s Hospital. It typically involves the physician snipping off the polyp with forceps.

• Loop electrosurgical excision procedure (LEEP): In this procedure, the doctor uses a wire loop heated by electric current to cut away the polyp, according to Johns Hopkins Medicine. More precise than a polypectomy, this procedure is often used to remove abnormal cells that need to be tested for things like cervical cancer.

Whether or not you develop a cervical polyp isn’t something you can control. “Cervical polyps are not really preventable, but they rarely cause any serious problems,” Dr. York-Best says.

What you can do: Stay on top of your health care by regularly seeing your OB/GYN or other women’s healthcare provider, and remain alert for any unusual signs or symptoms. Polyps generally do not grow back once removed, but if you have a history of them, you may be at risk for developing them again, per Mount Sinai Hospital.