From the Guidelines
The management of an endocervical polyp typically involves surgical removal through polypectomy, which can be performed in an outpatient setting under local anesthesia. The procedure involves grasping the polyp with forceps or a polyp snare and twisting it off at its base, followed by cauterization of the site to control bleeding. Prior to removal, a thorough evaluation including a pelvic examination and possibly colposcopy should be conducted to confirm the diagnosis. All removed polyps should be sent for histopathological examination to rule out malignancy, although the risk is low (less than 1%) 1. Following polypectomy, patients may experience mild cramping and spotting for a few days, which can be managed with over-the-counter pain medications like ibuprofen 400-600mg every 6-8 hours as needed. Sexual intercourse and tampon use should be avoided for 1-2 weeks after the procedure to allow for healing. Follow-up examination is recommended after 4-6 weeks to ensure complete removal and healing. Recurrence is possible but uncommon, occurring in approximately 10-15% of cases. Endocervical polyps are typically benign estrogen-responsive growths, and their removal is important not only for symptom relief but also to exclude other pathologies that may present similarly.
Some key considerations in the management of endocervical polyps include:
- The size and location of the polyp, which can influence the choice of removal technique 1
- The presence of any unfavorable histologic features, which may necessitate further treatment or surveillance 1
- The patient's overall health and preferences, which can impact the decision to proceed with surgical removal or other management strategies 1
- The importance of proper specimen handling and histopathological examination to rule out malignancy 1
Overall, the goal of management is to provide effective and safe removal of the polyp, minimize the risk of complications, and ensure optimal patient outcomes.
From the Research
Management Plan for Endocervical Polyp
The management plan for a patient with an endocervical polyp may include:
- Removal of the polyp in an office setting 2
- Surgical dilatation and curettage 2
- Electrosurgical excision or hysteroscopic polypectomy 2
- Exploration of the cervical canal and uterine cavity by hysteroscopy to determine the exact origin of the polyp pedicle and to check for concurrent endometrial pathology 2
Diagnostic Approaches
Diagnostic approaches for endocervical polyps may include:
- Routine gynaecological examination 2
- Colposcopy 2
- Filling defects on hysterosalpingogram 2
- Gynaecological ultrasound (abdominal, transvaginal or sonohysterography) 2
- Endometrial biopsy 2
- Diagnostic hysteroscopy to determine the location, number, and size of cervical polyps 2
Special Considerations
In certain cases, such as pregnancy, conservative management of endocervical polyps may be considered 3
- A study reported a case of a huge symptomatic endocervical polyp in pregnancy that was managed conservatively by polypectomy at 38 weeks of gestation without complications 3
Histological Evaluation
Histological evaluation of endocervical polyps is important to rule out dysplasia or malignancy:
- A study found that the overall risk of dysplasia in endocervical polyps was 0.2% 4
- Patients with dysplastic polyps were younger and more likely to have abnormal cervical cytological results before polyp removal 4
Comparison with Endometrial Polyps
Endocervical polyps can be compared with endometrial polyps in terms of diagnosis and management:
- A review article summarized the literature on the diagnosis and management of endometrial polyps, highlighting the importance of hysteroscopic resection and histologic assessment 5
- Uterine polyps with features overlapping with those of Müllerian adenosarcoma have a benign clinical course, even with conservative management 6