Endometrial polyps. An evidence-based diagnosis and management guide

Area of Science:

• Gynecology
• Reproductive Medicine
• Diagnostic Imaging

Background:

• Endometrial polyps are common, potentially impacting fertility and presenting diagnostic challenges.
• Current management guidelines require updating based on recent evidence.

Purpose of the Study:

• To provide updated practice guidelines for the diagnosis and management of endometrial polyps.
• To consolidate evidence on diagnostic modalities and treatment strategies.

Main Methods:

• Systematic literature search across major databases (MEDLINE, Scopus, EMBASE, etc.) up to May 2020.
• Recommendations developed by expert committee following AGREE II guidelines.
• Grading of trial evidence using the United States Preventive Services Task Force system.

Main Results:

• Transvaginal ultrasonography (TVUS) is the preferred imaging for fertile-aged women; accuracy improves with Doppler, 3D, and contrast.
• In-office hysteroscopy offers highest diagnostic accuracy for infertile patients.
• Hysteroscopic polypectomy is safe and effective; Dilation and Curettage (D&C) should be avoided.
• Saline-infused sonohysterography is accurate for asymptomatic postmenopausal women.
• Histopathological analysis is mandatory due to malignancy risk.

Conclusions:

• TVUS and in-office hysteroscopy are key diagnostic tools.
• Hysteroscopic polypectomy is recommended for symptomatic women and those desiring conception.
• Management of asymptomatic polyps varies by menopausal status and polyp size/risk factors.
• Avoid blind D&C; consider hysterectomy for hyperplasia/carcinoma.