Endometrial Polyps

Endometrial and endocervical polyps are common intrauterine lesions characterized by focal overgrowth of glands and stroma. Prevalence increases with age, obesity, ovulatory disorders, and tamoxifen use. The lesions may be asymptomatic or linked to infertility, abnormal uterine bleeding (AUB), or cancer, a rare diagnosis in the early reproductive years. Polyps frequently cause postmenopausal bleeding; before menopause, the typical presenting AUB symptom (AUB-polyp) is intermenstrual bleeding. The role that polyps play in infertility or in reducing the success of assisted reproductive techniques remains unclear. Diagnosis usually begins with transvaginal ultrasonography (TVUS), confirmed, at least for endometrial polyps, by sonohysterography, an office technique readily performed by the gynecologist. Color Doppler and power Doppler may help distinguish benign polyps from those with premalignant or malignant histology, but neither has been demonstrated to be equivalent to histopathologic evaluation. Expectant management might be suitable for small, asymptomatic polyps. Still, for most, hysteroscopic polypectomy is an effective and safe procedure that is preferably performed in an office or clinic environment without the need for systemic anesthesia. This approach reduces the direct costs of care and socioeconomic effects on the patient. Medical treatments, such as a levonorgestrel-releasing intrauterine device, may alleviate symptoms or reduce postsurgical recurrence but are not considered first-line options. Where there is ready access to TVUS, we recommend TVUS and sonohysterography for diagnosis, allowing hysteroscopic polypectomy to be reserved for those known to have polyps based on these highly sensitive and specific diagnostic techniques.