An endocervical polyp is a small, finger-like growth that develops from the glandular tissue lining the inside of the cervical canal, which is the narrow passage connecting the uterus to the vagina. These polyps are the most common type of cervical polyp and are almost always benign, with cancerous polyps occurring in less than 1% of all cases. Most are found in premenopausal women, often during a routine pelvic exam.
Where Endocervical Polyps Grow
The cervix has two distinct zones: the endocervix (the inner canal) and the ectocervix (the outer portion visible during a pelvic exam). Endocervical polyps specifically arise from the glands inside the canal. They attach to the canal wall by a stalk, which can be long and thin or short and broad. Because of this stalk, the polyp sometimes dangles through the cervical opening, making it visible during an exam even though it originated deeper inside.
These growths are typically tear-shaped or lobular. They can appear as a single polyp or in clusters, and their color ranges from red to purple to grayish. Size varies widely. Some are just a few millimeters across, while others grow large enough to be noticed on imaging or felt during an exam. Internally, they’re made up of loose connective tissue packed with blood vessels of varying sizes, which is why they tend to bleed easily when touched.
What Causes Them
The exact cause isn’t fully established, but several factors are strongly linked to their development. Estrogen plays a central role. The cervical glands are sensitive to this hormone, and elevated or fluctuating estrogen levels can stimulate overgrowth of the tissue lining the canal. This hormonal connection helps explain why endocervical polyps are most common during the reproductive years, when estrogen levels are highest.
Chronic inflammation of the cervix also contributes. Repeated irritation from infections, persistent vaginal discharge, or chemical exposure (such as from frequent douching) can trigger the tissue to overgrow as part of a healing response. Congestion of the small blood vessels in the cervical canal is another proposed mechanism. When blood flow in those vessels becomes sluggish or backed up, the surrounding tissue can swell and eventually form a polyp.
Common Symptoms
Many endocervical polyps cause no symptoms at all and are discovered incidentally during a pelvic exam or ultrasound. When symptoms do appear, they typically involve abnormal vaginal bleeding. The most recognizable patterns include:
- Bleeding after intercourse. Because polyps are rich in blood vessels and have a fragile surface, even gentle contact can cause spotting.
- Bleeding between periods. Irregular spotting unrelated to your menstrual cycle is one of the more common reasons polyps get investigated.
- Heavier menstrual periods. Some women notice their periods become unusually heavy after a polyp develops.
- Postmenopausal bleeding. Any vaginal bleeding after menopause warrants evaluation, and a polyp is one of the more benign explanations.
- Unusual discharge. A white or yellowish mucus discharge can sometimes accompany polyps, particularly if there’s associated inflammation.
These symptoms overlap with many other gynecological conditions, so bleeding or discharge alone doesn’t confirm a polyp. But if you’re experiencing any of these patterns, the cause is usually straightforward to identify.
How They’re Found and Diagnosed
Most endocervical polyps are spotted during a routine pelvic exam. If a polyp has grown through the cervical opening, it’s directly visible when the speculum is placed. Polyps that remain higher in the canal may be detected through transvaginal ultrasound or during a procedure called hysteroscopy, where a thin camera is inserted through the cervix to view the canal and uterine cavity.
Once identified, the polyp itself often provides enough visual information for an initial assessment. However, definitive diagnosis requires removing the polyp and sending it to a pathology lab for microscopic examination. This step confirms whether the tissue is benign and rules out any precancerous or cancerous changes.
Endocervical vs. Ectocervical Polyps
Ectocervical polyps are the less common type and grow from the outer surface of the cervix rather than from inside the canal. They tend to occur in postmenopausal women, while endocervical polyps are more typical before menopause. The tissue composition also differs. Endocervical polyps contain glandular tissue and loose, fluid-rich connective tissue with prominent blood vessels. Ectocervical polyps are covered with the same type of flat cells found on the outer cervix and tend to have a firmer structure. Both types are overwhelmingly benign, but the distinction matters because it can influence how and where a clinician looks for them.
Removal and What to Expect
Small, asymptomatic polyps don’t always require immediate treatment, but removal is generally recommended because it eliminates symptoms, allows the tissue to be examined under a microscope, and prevents the rare possibility of future changes. The procedure is usually quick and can often be done in an office setting without general anesthesia.
The most common technique involves grasping the polyp at its base with a specialized instrument and gently twisting until the stalk detaches. For polyps with a broader base or those located higher in the canal, electrosurgical tools or a hysteroscopic approach may be used to ensure complete removal. Most women experience mild cramping during the procedure and light spotting afterward, but recovery is fast. Normal activities can typically resume within a day or two.
After removal, the tissue is sent for pathological analysis. This is standard practice regardless of how the polyp looks. One large review of over 2,400 polyps found that among premenopausal women, the rates of malignancy, precancerous changes, and atypical cells were 0.1%, 0.7%, and 1.9% respectively. Another study examining 369 polyps found clinically significant findings in about 3.7% of cases, though the vast majority of those were low-grade changes rather than cancer. The takeaway: serious findings are uncommon, but lab analysis is the only way to confirm a polyp is completely benign.
Cancer Risk in Context
The overwhelming majority of endocervical polyps are harmless. Malignant polyps occur in fewer than 1 in 100 cases overall, and that small risk is concentrated in postmenopausal women. For premenopausal women, the chance of a polyp being cancerous is extremely low. That said, some polyps can develop precancerous changes over time, which is why removal and lab examination remain the standard approach rather than simply monitoring them.
Can They Come Back?
Polyps can recur after removal. The recurrence rate varies widely depending on individual factors and how long the follow-up period is. Some studies report recurrence in as few as 2.5% of patients, while others tracking women over longer periods have found rates as high as 43%. The wide range reflects differences in study design, but the practical point is that having a polyp removed doesn’t guarantee a new one won’t develop. The underlying factors that caused the first polyp, such as hormonal patterns or chronic cervical inflammation, may still be present. Routine gynecological exams help catch any recurrence early.