From the Guidelines
Endometrial polyps causing menorrhagia should be managed with hysteroscopic resection.
Diagnosis and Management
- The initial diagnosis of an endometrial polyp can be made using transvaginal ultrasound (TVUS) 1.
- If the initial TVUS demonstrates a focal endometrial abnormality, US sonohysterography can be used to further characterize the lesion and distinguish between leiomyomas and endometrial polyps with high accuracy 1.
- However, US sonohysterography cannot distinguish between benign endometrial pathology and endometrial cancer with a high degree of certainty, and endometrial sampling or direct visualization with hysteroscopy is recommended in women with suspected endometrial pathology 1.
- Hysteroscopic resection is the recommended treatment for endometrial polyps causing menorrhagia, especially if medical treatment fails or is contraindicated 1.
- Medical treatments, such as progestin-only contraception and combined hormonal contraception, can be used to manage abnormal uterine bleeding associated with ovulatory dysfunction, but are not the primary treatment for endometrial polyps 1.
From the Research
Management of Endometrial Polyps Causing Menorrhagia
To manage an endometrial polyp causing menorrhagia (heavy menstrual bleeding) diagnosed by ultrasound, the following options are available:
- Expectant management: This approach is suitable for asymptomatic women, as endometrial polyps may regress spontaneously 2.
- Medical management: Options include tranexamic acid, levonorgestrel intrauterine device, and hormonal therapy 3, 4, 5.
- Surgical management: Hysteroscopic resection of the polyp, endometrectomy, or hysterectomy may be necessary in some cases 3, 4, 6.
Diagnostic Evaluation
A pelvic examination and vaginal sonography should be performed to assess the patient's condition and rule out other causes of menorrhagia 5. Endometrial biopsy may also be necessary to eliminate the possibility of endometrial cancer 4, 5.
Treatment Considerations
The choice of treatment depends on the patient's symptoms, risks for malignancy, and personal preferences 3. It is essential to consider the patient's fertility desires and overall health when selecting a treatment option 6. A "see-and-treat" hysteroscopy approach can be effective in managing endometrial polyps, allowing for simultaneous diagnosis and treatment 6.