Synopsis
Distinguish fibroids, endometrial polyps and adenomyosis by compartment and symptom pattern, select ultrasound or hysteroscopy, and match medical, hysteroscopic, radiological or surgical treatment to anatomy and fertility priorities.
- Fibroids are benign myometrial smooth-muscle tumours; submucosal lesions distort the cavity and commonly drive bleeding, intramural lesions enlarge the wall and subserosal lesions more often cause pressure.
- Endometrial polyps are focal cavity overgrowths that commonly cause intermenstrual, postcoital or irregular bleeding and require histology when removed.
- Adenomyosis is endometrial-type tissue within myometrium, typically producing heavy painful periods, chronic pelvic pain and a diffusely bulky tender uterus.
Key red flags
Postmenopausal bleeding or a newly enlarging postmenopausal uterine or endometrial lesion requires urgent malignancy assessment rather than presumptive benign disease.
New growth, bleeding, pain or suspicious imaging after menopause requires urgent specialist assessment because a presumed fibroid diagnosis is not sufficient.
Investigation priorities
Exclude pregnancy-related bleeding and measure anaemia while structural assessment proceeds.
Management branches
Intermenstrual bleeding, imaging or HMB suggests a focal endometrial-cavity lesion.
- Offer outpatient hysteroscopy, explain analgesia and anaesthetic alternatives and obtain consent for biopsy or see-and-treat removal if appropriate.
- Remove a symptomatic polyp or suitable submucosal fibroid hysteroscopically and send all tissue for histological examination.