Clinical Management of Endometrial Polyps

Dear Colleagues,

Endometrial polyps are defined as a single or multiple localized overgrowth, sessile or pedunculate, of the endometrial glands and stroma around a vascular core protruding from the surface of the endometrium. Prevalence is reported to be between 7.8% to 34.9%.

Endometrial polyps can occur in reproductive age in patients with infertility or in premenopausal and postmenopausal patients with abnormal uterine bleeding. Sometimes asymptomatic, they can occasionally be diagnosed by ultrasound.

Clinical management of endometrial polyps consists in their removal, with hysteroscopic polypectomy representing the gold standard. Hysteroscopic technology makes it possible to perform a polypectomy in an office setting using various techniques such as mechanical removal with micro-scissors and grasping forceps, cutting with a bipolar electrode, or via tissue removal system. Each technique provides the necessary tissue for pathological examination. Although uncommon, both atypical hyperplasia and endometrial cancer may originate from endometrial polyps (within 0% to 12.9%).

The recurrence of endometrial polyps depends on the technique being used as well as on the pathogenesis of the pathology. Endometrial polyps do not represent a homogeneous pathogenesis: some depend on an ovarian steroid imbalance while others are of an inflammatory nature. This variance is reflected in different symptoms, oncologic consequences, and recurrence.

Management of endometrial polyps may be conservative, with spontaneous regression accounting for up to 25% of cases. Smaller polyps (< 10 mm) are more likely to regress, and asymptomatic postmenopausal polyps are unlikely to be malignant. In these cases, the observation must be discussed with the patient.

Dr. Oronzo Ruggiero Ceci and Dr. Mario Franchini

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