What is the difference between uterine fibroids and uterine polyps?

Jul 15, 2025 Source: Cainiu Health

Dr. Zhang Lu

Introduction

Under normal circumstances, uterine fibroids and endometrial polyps are two distinct uterine conditions, differing mainly in their locations, tissue characteristics, morphological features, symptom presentation, and risks of malignancy. In daily life, women should pay attention to their menstrual conditions and undergo regular gynecological examinations. Additionally, maintaining healthy lifestyle habits can help protect uterine health.

Generally, uterine fibroids and endometrial polyps are two distinct uterine conditions, differing mainly in their locations, tissue characteristics, morphological features, symptom presentations, and risks of malignancy. Detailed differences are as follows:

1. Different Locations of Onset: Uterine fibroids originate from the smooth muscle tissue of the uterus and can grow within the uterine muscular wall (intramural), beneath the serosal layer (subserosal), or under the mucosal layer (submucosal), with diverse locations—some protrude from the uterine surface, while others are located inside the uterus. Endometrial polyps primarily occur in the endometrium, composed of endometrial glands and stroma, commonly projecting into the uterine cavity, with a few occasionally growing within the cervical canal.

2. Different Tissue Characteristics: Uterine fibroids are benign tumors formed by the proliferation of smooth muscle cells. They have a relatively firm texture, clear boundaries from surrounding tissues, and possess a complete capsule. Endometrial polyps are hyperplastic outgrowths formed by localized overgrowth of the endometrium. They have a softer texture, appear tongue-shaped or finger-like, are loosely connected to surrounding tissues, and generally lack a capsule.

3. Different Morphological Features: Uterine fibroids vary significantly in size—some are only a few millimeters in diameter, while others can grow large enough to fill the entire pelvic cavity. They are usually round or oval in shape with a smooth surface. Endometrial polyps are typically smaller, with diameters mostly under 1 cm. They often have elongated or irregular shapes and may exhibit surface congestion.

4. Different Symptom Presentations: Uterine fibroids mainly cause heavy menstrual bleeding, prolonged menstrual periods, abdominal masses, and increased vaginal discharge. Larger fibroids may compress the bladder or rectum, causing frequent urination or constipation. Endometrial polyps primarily present with intermenstrual bleeding, heavy menstrual bleeding, prolonged menstruation, or irregular vaginal bleeding. They generally do not form noticeable masses and rarely cause compressive symptoms.

5. Different Risks of Malignant Transformation: The risk of malignancy in uterine fibroids is extremely low, with only about 0.4%–0.8% undergoing sarcomatous transformation, more commonly seen in fibroids that rapidly enlarge after menopause. The risk of malignancy in endometrial polyps is slightly higher than that of uterine fibroids, particularly in older patients with abnormal uterine bleeding, among whom a small number may develop endometrial cancer, thus requiring attention.

In daily life, women should pay attention to their menstrual conditions and undergo regular gynecological examinations. If uterine abnormalities are detected, appropriate management options such as observation, medication, or surgery can be selected based on specific conditions. Maintaining healthy lifestyle habits also contributes to uterine health.

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Why did uterine fibroids grow again after surgery?

In general, the recurrence of uterine fibroids after surgery may be caused by hormonal fluctuations, unhealthy lifestyle habits, adenomyosis, polycystic ovary syndrome, hyperprolactinemia, or other factors. If discomfort symptoms occur, it is recommended to seek timely medical evaluation and treatment at a正规 hospital. In daily life, maintain a light diet and avoid high-fat and high-sugar foods.

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Does a 40-year-old with uterine polyps necessarily require surgery?

In general, whether a 40-year-old woman with uterine polyps requires surgery depends on the specific characteristics of the polyps, symptom presentation, and the patient's individual needs. If abnormal symptoms occur, prompt medical evaluation is recommended to confirm diagnosis. Daily hygiene practices should include keeping the external genital area clean by washing with warm water, frequently changing cotton underwear, and avoiding unhygienic contact. In terms of diet, intake of spicy foods and those high in estrogen should be reduced.

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Can I take dydrogesterone tablets if I have uterine fibroids?

If uterine fibroids are less than 5 cm in diameter, grow slowly, and the patient has no obvious symptoms such as heavy menstrual bleeding or abdominal pain, and if the patient also has conditions like menstrual irregularity or low progesterone levels in early pregnancy requiring fetal preservation, oral dydrogesterone tablets may be prescribed for short-term use after physician evaluation. In such cases, the medication primarily serves to regulate hormones and maintain pregnancy, with minimal impact on the fibroids.

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Can uterine fibroids be completely removed by hysteroscopic surgery?

Whether uterine fibroids can be completely removed during hysteroscopic surgery depends on the location and size of the fibroids. Submucosal fibroids or intramural fibroids protruding into the uterine cavity can usually be thoroughly excised. However, deeply intramural fibroids, subserosal fibroids, or cases with multiple or large fibroids are more difficult to completely remove and are prone to residual tissue. After surgery, patients should follow medical advice regarding medication to prevent infection and maintain external genital hygiene.