Management of Recurrent Endometrial Polyps in Women Trying to Conceive
For recurrent endometrial polyps in a woman attempting pregnancy, proceed with hysteroscopic polypectomy followed by 6 months of progestin therapy (preferably levonorgestrel-releasing intrauterine device) to prevent recurrence, then actively pursue conception through assisted reproductive technologies if needed.
Immediate Surgical Management
- Hysteroscopic polypectomy is the definitive treatment for your recurrent polyps, as blind dilatation and curettage should be avoided for polyp removal 1, 2
- Office hysteroscopy with "see and treat" approach is feasible, safe, and can often be performed without anesthesia 1, 2
- Complete polyp removal under hysteroscopic guidance is the recommended surgical treatment, as it allows both visualization and effective resection 3, 2
Post-Polypectomy Prevention Strategy
The critical step after polyp removal is preventing recurrence before you conceive:
- Levonorgestrel-releasing intrauterine device (LNG-IUS) is the preferred method for preventing polyp recurrence, as it provides higher regression rates, lower recurrence rates, and fewer adverse events compared to oral progestins 4, 5
- Maintenance progestin treatment for at least 6 months provides optimal endometrial protection 4
- Alternative oral progestins include medroxyprogesterone acetate (400-600 mg/day) or megestrol acetate (160-320 mg/day) if LNG-IUS cannot be used 4, 6
Monitoring During Prevention Phase
- Perform endometrial sampling (biopsy or D&C) every 3-6 months during progestin treatment to ensure no pathological changes 4, 6
- Continue treatment until no pathological changes are detected in two consecutive endometrial biopsies 5
- After the 6-month treatment period, continue regular follow-up every 6 months to monitor for late recurrence 4
Fertility Considerations
Once polyp recurrence prevention is complete, actively pursue pregnancy:
- Women with unexplained infertility may benefit from endometrial polypectomy for future natural pregnancy 7
- Patients who achieve disease remission should be advised to seek assistance through assisted reproductive technologies to optimize conception timing 5
- Consultation with a fertility specialist is recommended prior to and after completing the prevention therapy 8
Important Contraindications to Progestin Therapy
Use progestin cautiously or avoid if you have: 4, 6
- History of breast cancer
- Stroke or myocardial infarction
- Pulmonary embolism or deep vein thrombosis
- Active smoking
Why This Approach Matters
The recurrence rate after polypectomy alone is significant, and approximately 25% of polyps may resolve spontaneously, but your history of multiple recurrences indicates you need active prevention 3. The 6-month progestin window provides endometrial protection while minimizing delay in your fertility goals. Pregnancy itself will provide additional protective benefit through high progesterone levels, though it does not eradicate lesions completely 9.