"See-and-Treat" Hysteroscopy in the Management of Endometrial Polyps

Endometrial polyps (EPs) are a common cause of abnormal uterine bleeding (AUB) in perimenopausal and postmenopausal women and are typically suggested by a screening transvaginal ultrasound. In addition, the increasing use of pelvic imaging often discloses asymptomatic EPs. In the past, saline infusion sonography (SIS) has been advocated in order to triage patients to undergo a blind curettage or a diagnostic or operative hysteroscopy. The introduction of small diameter hysteroscopes and resectoscopes-often no larger than a SIS catheter-now allows most women with abnormal ultrasound findings to undergo a single-stage "see-and-treat" hysteroscopy for the management of endometrial polyps. In order to provide optimal management of endometrial polyps, however, a variety of known and unknown factors must be considered prior to "see-and-treat" hysteroscopy. For a woman wishing to preserve or enhance her fertility, hysteroscopic polypectomy-with care to avoid collateral endometrial damage-remains the standard of care. However, the literature reveals three issues that are important to address. First, that many premalignant and malignant lesions are found at the polyp base. Second, that there is a significant recurrence risk following simple polypectomy; this is especially true in tamoxifen-treated women. Third, that polypectomy alone is often insufficient for the satisfactory management of AUB. By offering a variety of options to women undergoing hysteroscopic polypectomy-including partial or total endomyometrial resection-the author addresses many of the limitations of traditional polypectomy. Moreover, the use of small diameter hysteroscopes and resectoscopes allow these procedures to be performed as a single stage "see-and-treat" hysteroscopy in the comfort and safety of an office-based setting.