Hysteroscopic polypectomy is a minimally invasive procedure that removes polyps from inside the uterus using a thin, lighted camera called a hysteroscope. It is the most commonly performed hysteroscopic surgery worldwide, typically done as an outpatient procedure that takes anywhere from 7 to 35 minutes depending on the setting and complexity.
Uterine polyps are small growths on the inner lining of the uterus. Most are benign, but they can cause heavy or irregular periods, bleeding between periods, postmenopausal bleeding, and in some cases, difficulty getting pregnant. The procedure both removes the polyps and allows the surgeon to visually inspect the uterine cavity for other abnormalities at the same time.
Why the Procedure Is Done
Abnormal uterine bleeding is the most common reason for hysteroscopic polypectomy. This includes periods that are unusually heavy, bleeding that occurs outside your normal cycle, and any vaginal bleeding after menopause. In many of these cases, polyps turn out to be the root cause.
The procedure is also used for women experiencing unexplained infertility. Polyps can interfere with embryo implantation, and removing them appears to meaningfully improve the odds of conception. In one study of previously infertile women whose only identified issue was uterine polyps, 61.4% achieved spontaneous pregnancy after polypectomy, and 54.2% delivered at term. The improvement held regardless of whether the polyps were small, large, or multiple.
How the Procedure Works
The hysteroscope, a thin tube with a camera and light, is inserted through your vagina and cervix into the uterus. No incisions are needed. A fluid is used to gently expand the uterine cavity, giving your surgeon a clear view on a monitor. Once the polyp is identified, surgical instruments passed through the hysteroscope are used to cut and remove it. The removed tissue is sent for lab analysis to confirm it’s benign.
Surgeons use one of two main approaches to remove the polyp. The traditional method, called resectoscopy, uses an electrically heated loop to slice through the polyp’s base. This has the advantage of sealing blood vessels as it cuts, which controls bleeding. The downside is that the heat can damage surrounding healthy tissue, potentially leading to scarring inside the uterus. This is a particular concern for women planning future pregnancies, since scarring can reduce the chances of embryo implantation.
The newer approach, called hysteroscopic morcellation, uses a small rotating blade that simultaneously cuts and suctions polyp tissue out of the uterus. Because it doesn’t use heat, there’s no thermal damage to the surrounding uterine lining. It also keeps the surgical view clearer during the procedure, since it removes tissue fragments continuously rather than letting them accumulate. However, morcellation can have difficulty with very tough or fibrous tissue and is less effective at stopping bleeding during the procedure.
Anesthesia and Preparation
The level of anesthesia depends on the complexity of the procedure and where it’s performed. Simple polypectomies done in an office setting may require only local anesthesia or even no anesthesia at all, sometimes with a sedative to help you relax. More complex cases performed in an operating room typically use regional or general anesthesia.
Before the procedure, your surgeon may have you take a medication to soften and open the cervix, making it easier to insert the hysteroscope. This cervical preparation is most commonly done with a tablet placed vaginally several hours before surgery. Using this kind of preparation significantly reduces the need for the cervix to be mechanically stretched open during the procedure.
Recovery Timeline
Most people resume daily activities within a day or two. You should avoid strenuous exercise and sports for about one week. For two weeks after surgery, nothing should be placed in the vagina: no tampons, no sexual intercourse, no douching. Baths, hot tubs, and swimming are also off-limits for those same two weeks to reduce infection risk. Showers are fine.
Some cramping and light spotting in the days following the procedure is normal. When done as an outpatient procedure, many people go home the same day. If general anesthesia was used, you’ll be monitored for a short period while you recover from sedation before being discharged. Most people return to work within one to three days depending on the nature of their job and the type of anesthesia used.
Risks and Complications
Hysteroscopic polypectomy is considered safe, but like any surgical procedure, it carries some risk. The most frequently reported complications are bleeding (about 2.4% of cases), uterine perforation (0.8% to 1.5%), and minor cervical tears (1% to 11%, usually requiring no additional treatment). Fluid overload, a condition where the liquid used to expand the uterus is absorbed into the bloodstream, occurs in fewer than 5% of cases but can be serious when it happens.
Uterine perforation, where an instrument accidentally passes through the uterine wall, is rare and in most cases heals on its own without further surgery. Your surgeon monitors fluid levels throughout the procedure to catch any overload early.
Polyp Recurrence After Removal
Polyps can grow back. Reported recurrence rates vary widely depending on how long patients are followed, ranging from as low as 2.5% to 3.7% at nine years in some studies to around 13% at two years in others. One retrospective study found a first recurrence rate of about 24%, though this likely reflects the fact that the study only included women who had follow-up hysteroscopies, which would catch polyps that might otherwise go unnoticed.
Recurrence doesn’t necessarily mean you’ll have symptoms again, and a repeat polypectomy can be performed if needed. There’s no strong evidence that the technique used, whether resectoscopy or morcellation, significantly affects how likely polyps are to return.
Impact on Fertility
For women trying to conceive, the procedure offers a clear benefit. Polyps can physically interfere with how a fertilized egg attaches to the uterine wall, and heat-based removal techniques carry the additional risk of damaging the surrounding lining. This is one reason morcellation is often preferred for patients planning pregnancy: it preserves more of the healthy endometrium and avoids the thermal scarring that can reduce implantation rates.
The first-trimester miscarriage rate after polypectomy is around 6%, which is well within the normal range for any pregnancy. The size and number of polyps removed do not appear to affect fertility outcomes, so even women with larger or multiple polyps can expect similar improvement in their chances of conceiving.