From the Guidelines
Cervical polyps can indeed lead to abnormal uterine bleeding (AUB), as they are a type of structural cause that can disrupt normal uterine bleeding patterns. According to the American College of Radiology Appropriateness Criteria 1, structural causes of AUB include endometrial polyps, adenomyosis, leiomyoma, malignancy, and endometrial hyperplasia. While the provided evidence primarily focuses on endometrial polyps, it is essential to note that cervical polyps can also cause AUB due to their fragile blood vessels, potential for inflammation or infection, and possible torsion or necrosis.
Key Points to Consider
- Cervical polyps are benign growths that protrude from the cervical canal and can cause irregular spotting or bleeding, particularly after intercourse or douching 1.
- These polyps are composed of endocervical tissue with a vascular core, making them prone to bleeding when irritated or traumatized.
- Treatment involves simple polypectomy, usually performed in an office setting without anesthesia, and the removed polyp should be sent for pathological examination to rule out malignancy.
Diagnostic Approach
The diagnostic approach for AUB, as outlined in the American College of Radiology Appropriateness Criteria 1, involves initial imaging with combined transabdominal and transvaginal ultrasound of the pelvis with Doppler. If the uterus is incompletely visualized, MRI of the pelvis without and with contrast may be necessary. However, if a polyp is suspected, sonohysterography can be performed.
Management and Outcome
After removal of the cervical polyp, bleeding typically resolves completely, and recurrence is uncommon 1. Women with persistent or recurrent bleeding after polyp removal should undergo further evaluation to identify other potential causes of AUB. In summary, cervical polyps are a potential cause of AUB, and their removal can lead to resolution of bleeding, highlighting the importance of considering structural causes in the evaluation and management of AUB.
From the Research
Cervical Polyps and Abnormal Uterine Bleeding (AUB)
- Cervical polyps are not directly mentioned as a cause of AUB in the provided studies, however, the PALM-COEIN classification system is discussed in several studies 2, 3, which includes polyps as a structural entity that can cause AUB.
- The PALM-COEIN system classifies the etiologies of AUB into two main categories: structural (PALM) and non-structural (COEIN) 2, 3.
- Polyps are included in the PALM category, along with other structural entities such as adenomyosis, leiomyoma, malignancy, and hyperplasia 2, 3.
- While the studies do not specifically discuss cervical polyps as a cause of AUB, they do suggest that polyps can be a contributing factor to abnormal uterine bleeding 2, 3.
- Endometrial polyps, on the other hand, are discussed in one of the studies as a common gynecologic condition associated with abnormal uterine bleeding, infertility, and premalignant and malignant conditions 4.
Diagnosis and Treatment of AUB
- The diagnosis and treatment of AUB depend on the underlying cause, and may involve medical or surgical options 2, 5, 3, 6.
- Medical treatments for AUB include levonorgestrel intrauterine devices, oral contraceptive pills, and tranexamic acid 2, 3, 6.
- Surgical treatment options for AUB include endometrial ablation and hysterectomy 2, 5, 3, 6.
- Hysteroscopy is a minimally invasive procedure that can be used to diagnose and treat endometrial polyps and other structural causes of AUB 4.