From the Guidelines
Endometrial polyps are typically treated through surgical removal via hysteroscopic polypectomy, which is the most effective treatment approach. This minimally invasive procedure involves inserting a thin scope through the cervix to visualize and remove the polyp, usually performed as an outpatient procedure with minimal recovery time. For small, asymptomatic polyps in premenopausal women, watchful waiting may be appropriate as some polyps resolve spontaneously. Hormonal medications like progestins (such as medroxyprogesterone acetate 10mg daily for 10-14 days) may temporarily reduce symptoms but generally don't eliminate polyps completely. After treatment, follow-up monitoring is recommended as polyps can recur in 15-20% of cases. The choice of treatment depends on factors including polyp size, symptoms (abnormal bleeding, infertility), age, menopausal status, and cancer risk factors. Surgical removal is particularly important for postmenopausal women due to the small risk (approximately 3-5%) that polyps may contain cancerous cells. For women planning pregnancy, polyp removal is recommended as polyps can interfere with embryo implantation and fertility.
Key Considerations
- The treatment approach should prioritize minimizing morbidity, mortality, and optimizing quality of life 1.
- Surgical removal via hysteroscopic polypectomy is generally the preferred treatment for endometrial polyps due to its effectiveness and minimal invasiveness.
- The decision to treat should consider the patient's overall health, symptoms, and reproductive plans.
- Follow-up care is essential to monitor for recurrence and address any new symptoms promptly.
Treatment Options
- Hysteroscopic polypectomy: A minimally invasive surgical procedure to remove the polyp.
- Watchful waiting: For small, asymptomatic polyps in premenopausal women, with regular follow-up to monitor for changes.
- Hormonal medications: May be used to manage symptoms but are not a definitive treatment for polyps.
Special Considerations
- Postmenopausal women: Surgical removal is recommended due to the risk of cancerous cells within the polyp.
- Women planning pregnancy: Polyp removal is recommended to prevent interference with embryo implantation and fertility. The most recent and highest quality study 1 supports the use of hysteroscopic polypectomy as the primary treatment for endometrial polyps, emphasizing the importance of individualized care based on patient factors and symptoms.
From the Research
Treatment Options for Endometrial Polyps
The treatment options for endometrial polyps include:
- Expectant management: This approach is suitable for asymptomatic premenopausal and postmenopausal women, as about 25% of polyps resolve spontaneously if managed conservatively 2.
- Medical management: Although there is no proven preventative or medical treatment for endometrial polyps, some studies suggest that medical therapy may be an option for managing symptoms 3.
- Surgical management: The usual management of endometrial polyps, symptomatic or asymptomatic, is polypectomy, performed primarily to exclude malignancy within the polyp despite the overall risk of malignancy being low (about 3%) 2. Hysteroscopic polypectomy is a recommended surgical treatment, which can be performed in an office setting or operating room, with high patient satisfaction reported following the procedure 4, 5.
Factors Influencing Treatment Choice
The choice of treatment for endometrial polyps depends on several factors, including:
- Symptoms: Women with abnormal uterine bleeding or other symptoms may require surgical management, while asymptomatic women may be managed expectantly 2, 3.
- Risk of malignancy: The risk of malignancy is higher in postmenopausal women and those with abnormal uterine bleeding, making polypectomy a recommended approach for these groups 2, 5.
- Patient preference: Patients may decline surgical management due to the small inherent risks, and conservative management may be an option for asymptomatic women 2.