From the Guidelines
Management of endometrial polyp causing menorrhagia should start with medical treatment, such as progestin-only contraception or combined hormonal contraception.
Medical Management
- Medical treatments, including progestin-only contraception and combined hormonal contraception, are recommended as the initial management for abnormal uterine bleeding associated with ovulatory dysfunction, which includes endometrial polyps 1.
- These medical treatments can help reduce heavy menstrual bleeding and manage symptoms.
Surgical Management
- If medical treatment fails, is contraindicated, or not tolerated, or if the patient has concomitant significant intracavitary lesions, surgery, including endometrial ablation and hysterectomy, may be considered as an option 1.
- Hysteroscopic resection can be used to remove endometrial polyps, especially if they are causing significant symptoms.
- Sonohysterography can be used to further characterize endometrial observations on transvaginal ultrasound (TVUS) and help distinguish between leiomyomas and endometrial polyps 1.
Diagnostic Evaluation
- Transvaginal ultrasound (TVUS) is the initial imaging study of choice for evaluating abnormal uterine bleeding, including endometrial polyps 1.
- Sonohysterography can be used to confirm the diagnosis of endometrial polyps and to assess the location and size of the polyp 1.
- MRI can be used to further evaluate the uterus and exclude other conditions, such as adenomyosis or leiomyosarcoma 1.
From the Research
Management of Endometrial Polyps Causing Menorrhagia
To manage an endometrial polyp causing menorrhagia diagnosed by ultrasound, the following options are available:
- Expectant management: This approach may be suitable for asymptomatic women, as endometrial polyps can regress spontaneously 2.
- Medical management: Options include tranexamic acid, levonorgestrel intrauterine device, and non-steroidal anti-inflammatory drugs, which can reduce menstrual blood loss by 20-60% 3, 4.
- Surgical management: Hysteroscopic resection of the polyp or endometrectomy may be necessary to remove the polyp and alleviate symptoms 5, 2.
Diagnostic Evaluation
A pelvic examination and vaginal sonography should be performed to assess the patient's condition and rule out other causes of menorrhagia 4. Endometrial biopsy may also be necessary to eliminate the risk of endometrial cancer 3, 4.
Treatment Considerations
The choice of treatment depends on the patient's symptoms, risks for malignancy, and personal preferences 5. A thorough evaluation of the patient's condition and discussion of treatment options with a healthcare provider can help determine the best course of action. Treatment should be started with medical therapy, and surgical interventions should be considered if medical management is ineffective 4, 6.