Delayed bleeding after hysteroscopic polypectomy is a recognized complication, but its frequency, risk factors, and impact on patient behavior in real-world clinical practice remain understudied. A multicenter retrospective cohort study was conducted using 480 medical records of women who underwent hysteroscopic polypectomy between 2021 and 2025 in three Russian cities (Makhachkala, Nalchik, and Volgograd). Only women with regular menstrual cycles were included to allow valid assessment of bleeding misinterpretation. Any postoperative vaginal bleeding was documented in 47 patients (9.8% of 480). Of these, 23 cases (4.8%) were normal spotting within the first 3–5 days, while delayed pathological bleeding (primary outcome) occurred in 24 patients (5.0%). Independent risk factors for pathological bleeding included polyp size greater than 2 cm (OR 4.2, 95% CI 1.8–9.8, p<0.01), hot snare polypectomy (OR 3.5, 95% CI 1.5–8.2, p<0.01), and anticoagulant use (OR 5.1, 95% CI 2.0–13.0, p<0.001). Among patients with pathological bleeding, 70.8% mistook the bleeding for early menstruation and delayed seeking care for a median of 3 days. Only 39.0% of all medical records contained documented evidence that the patient had been warned about the possibility of delayed bleeding. These findings suggest that the burden of delayed bleeding after polypectomy is not only clinical but also informational. Simple preoperative counseling with clear criteria for differentiating normal healing from pathological bleeding might prevent delayed presentations.
