Endometrial polyps

Question 1

What is the prevalence of endometrial polyps?

Answer 1

10%

Question 2

What are the symptoms of polyps?

Answer 2

Asymptomatic
HMB
IMB
PCB
PMB
Abnormal vaginal discharge
Subfertility

Question 3

What are the diagnostic tests for polyps?

Answer 3

USS - TV/TA
Saline infused sonohysterogram
Hysteroscopy (gold standard)

Question 4

What is the management for endometrial polyp in a premenopausal woman?

Answer 4

Can be managed conservatively if:

• asymptomatic
• <1cm
• No subfertility
• No significant risk factors for endometrial pathology (e.g. high BMI)

Otherwise:

• Hysterocopy and polypecomty
• Myosure
• resectoscope

Question 5

Indications for surgical management of endometrial polyps?

Answer 5

• Post-menopausal
• > 1cm
• Subfertility
• AUB

Question 6

What is the risk of recurrence after surgical removal?

Answer 6

15-40%

Question 7

What is the risk of endometrial cancer in women with endometrial polyps?

Answer 7

1.3%

Question 8

How can recurrence of endometrial polyp be prevented?

Answer 8

Mirena IUD proven to significantly reduce recurrence in large cohort studies.

Question 9

What is the pathophysiology of polyp formation?

Answer 9

• Hyperplastic overgrowth of endometrial glands and stroma, causing outgrowth beyond normal endometrium
• Increased expression of E&P receptors in polyps
• Reduced apoptosis

Question 10

Hysteroscopic findings concerning for malignancy?

Answer 10

Size >1cm
Area of necrosis
White thickened areas
increased vascularity
Surface irregularity