When should cervical polyps be removed?

When to Remove Cervical Polyps

Cervical polyps should be removed when they are symptomatic (causing abnormal bleeding, discharge, or discomfort) or when there is suspicion for malignancy, regardless of size. 1, 2

Indications for Cervical Polyp Removal

Symptomatic Polyps

• Polyps causing intermenstrual bleeding, postcoital bleeding, or abnormal vaginal discharge should be removed 1, 2
• Polyps causing lower abdominal discomfort or pain require removal 3

Asymptomatic Polyps with Concerning Features

• Large polyps (>4 cm) should be removed due to higher risk of malignancy 4
• Polyps with atypical appearance on colposcopy should be removed 5
• Polyps in postmenopausal women should be removed due to higher risk of premalignant and malignant lesions 1

Special Considerations

• In pregnant women, polyp removal should be deferred until after delivery unless invasive cancer is suspected 5
• In women with abnormal cervical cytology (ASC-H, HSIL), any polyps should be removed as part of the diagnostic evaluation 5

Procedure for Removal

Outpatient Setting

• Asymptomatic polyps in low-risk patients can be removed in an outpatient setting without anesthesia 6, 2
• Ring-forceps polypectomy technique is recommended for primary care providers 2

Hospital Setting

• Symptomatic polyps should be removed under general anesthesia with concurrent endometrial sampling (D&C) 6
• Giant polyps (>4 cm) may require more extensive surgical approaches including hysteroscopic resection 3, 4

Follow-up After Removal

• All removed polyps should be sent for histopathological examination 1, 2
• If CIN is identified on histopathology, follow-up should be according to CIN management guidelines 5
• For benign polyps with negative margins, routine cervical cancer screening can be resumed 5

Risk of Malignancy

• The risk of premalignant lesions in cervical polyps is approximately 2% 1
• The risk of malignant lesions is approximately 0.3%, primarily in postmenopausal women 1
• Endometrial sampling should be considered along with polypectomy in postmenopausal women due to the association between cervical polyps and endometrial pathology 1

Pitfalls to Avoid

• Do not assume all polyps are benign, especially in postmenopausal women or those with abnormal bleeding 1
• Do not perform endocervical curettage in pregnant women 5
• Do not neglect routine cervical cancer screening in women with cervical polyps 2
• Avoid unnecessary referrals to gynecology for asymptomatic small polyps in low-risk patients 2