What is the management of recurrent endocervical polyp in a 36-year-old woman?

From the Guidelines

For a 36-year-old woman with a recurrent endocervical polyp, I strongly recommend referral to an endoscopic referral center for polypectomy, especially given the recurrent nature of the polyp, as this approach is associated with better outcomes in terms of reducing recurrence risk and managing potential complications 1.

Key Considerations

• The decision to refer to an endoscopic referral center is based on the latest clinical practice update, emphasizing the importance of tailored approaches for polypectomy, particularly for recurrent polyps or those in challenging locations 1.
• The procedure should ideally be performed by experienced professionals in a setting equipped to handle any potential complications, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.
• Post-procedure care, including follow-up examinations, is crucial for monitoring recurrence and addressing any concerns or complications promptly.

Management and Prevention

• After polypectomy, it is essential to follow post-procedure instructions carefully, including abstaining from sexual intercourse and avoiding the use of tampons for a recommended period to facilitate healing.
• Consideration of hormonal management, such as the use of combined oral contraceptives, may be beneficial in preventing recurrence, especially if hormonal factors are suspected to contribute to polyp formation.
• Regular gynecological check-ups are vital for early detection of any recurrence or other gynecological issues, allowing for timely intervention and minimizing potential impacts on quality of life.

Underlying Pathology

• Recurrent endocervical polyps may indicate underlying endometrial pathology, and if standard treatments fail to prevent recurrence, further evaluation, including hysteroscopy, may be necessary to identify and address any underlying conditions.
• The histopathological examination of the removed polyp tissue is crucial for ruling out malignancy, although the majority of endocervical polyps are benign.

From the Research

Recurrent Endocervical Polyp in a 36-Year-Old Woman

Diagnosis and Treatment Options

• The diagnosis of endocervical polyps can be made using transvaginal ultrasonography, with color doppler increasing its diagnostic accuracy 2.
• Hysteroscopy is the gold standard for diagnosis and allows for both histological diagnosis and effective treatment 3, 2.
• The treatment of endocervical polyps usually involves removal of the polyp, with hysteroscopic polypectomy being a feasible and safe option 3, 2, 4.

Risk of Malignancy

• The risk of malignancy in endocervical polyps is low, with a prevalence of about 0.1-0.3% 5, 6.
• The main risk factors for malignancy are menopause and abnormal uterine bleeding, with hypertension, obesity, diabetes mellitus, and tamoxifen use thought to play a lesser role 3.

Management

• The management of endocervical polyps should be individualized and made in consultation with the patient 3.
• Routine removal of cervical polyps is not mandatory, but seems clinically prudent because pathological evaluation is needed to confirm the diagnosis and to rule out other possibilities 5, 6.
• Endometrial sampling should be recommended, especially for postmenopausal women, as cervical polyps can be a sign of endometrial disease 5, 6.

Recurrence

• There is no specific information available on the recurrence of endocervical polyps in the provided studies.
• However, the studies suggest that the removal of polyps is usually recommended to exclude malignancy and to treat symptoms such as abnormal uterine bleeding 3, 2, 4.