Management of Small Asymptomatic Cervical Polyp in a 63-Year-Old Woman
A small, asymptomatic cervical polyp in a 63-year-old postmenopausal woman should be removed and sent for histopathological examination, despite the absence of symptoms. 1, 2
Rationale for Removal
The primary justification for removing even asymptomatic cervical polyps in postmenopausal women is to exclude malignancy and premalignancy through histological examination, as visual inspection alone cannot reliably rule out dysplasia or cancer. 2, 3
Risk Profile in Postmenopausal Women
Postmenopausal women have a 0.1% risk of malignancy and 0.2% risk of dysplasia within cervical polyps, which is actually lower than premenopausal women (0.1% malignancy, 0.7% dysplasia). 3
However, when malignancy does occur in cervical polyps, it is most commonly found in perimenopausal to postmenopausal women (≥48 years), making age 63 a relevant risk factor despite overall low rates. 3
Premalignant lesions are found in 2% of cervical polyps in postmenopausal women, with malignant lesions in 0.3%, according to a large retrospective study. 2
The overall prevalence of "any abnormality" (malignancy, dysplasia, or atypia) is 1.4% in women ≥50 years, which is statistically lower than younger women but still clinically significant. 3
Clinical Practice Recommendations
Current consensus strongly suggests removal of all cervical polyps with subsequent histological review, regardless of symptom status or menopausal state. 2
Symptomatic endocervical polyps can be easily and painlessly removed by primary care clinicians in office using a ring-forceps polypectomy technique, avoiding unnecessary referrals and wait times. 1
For asymptomatic polyps in appropriate patients, office-based removal by primary care providers is acceptable and cost-effective, with specimens sent for histologic examination. 1
Procedural Approach
Simple ring-forceps polypectomy can be performed in the office setting without anesthesia, as the procedure is generally painless. 1
Hysteroscopic polypectomy may be considered if there is difficulty determining whether the polyp is cervical or endometrial in origin, or if concurrent endometrial pathology is suspected. 4
Up to 25% of patients with cervical polyps have coexisting endometrial polyps, making evaluation of the endometrial cavity important, particularly in postmenopausal women with bleeding. 4
Additional Considerations
Cervical Cancer Screening
The presence of a cervical polyp does not alter routine cervical cancer screening recommendations—patients should continue age-appropriate screening with cytology and/or HPV testing. 1
Cervical polyps alone are unlikely to be associated with dysplasia or malignancy; routine Papanicolaou and HPV tests remain the most important factors in identifying cervical dysplasia. 1
Evaluation of cervical smear cytology prior to polypectomy can provide information about malignancy potential, though normal cytology does not exclude the need for polyp removal. 2
Endometrial Evaluation
Along with cervical polypectomy, endometrial sampling should be recommended, especially for postmenopausal women, as there is a statistically significant association between menopausal status and endometrial pathology. 2
Premalignant and malignant lesions in endometrial histopathology were found in 1.33% and 0.66% of cases, respectively, in women undergoing cervical polypectomy. 2
Common Pitfalls to Avoid
Do not rely on visual inspection alone to determine benignity—histological examination is mandatory as appearance does not reliably predict pathology. 1, 2
Do not defer removal based solely on asymptomatic status—the absence of bleeding or other symptoms does not exclude the possibility of underlying dysplasia or malignancy. 2, 3
Do not assume that normal cervical cytology eliminates the need for polyp removal—cytology screens for cervical epithelial abnormalities, not polyp pathology. 1
Do not perform blind avulsion or twisting without histological examination—this outdated approach often leaves residual fragments and misses concurrent pathology. 4
Avoid unnecessary referral to gynecology for straightforward cases—primary care providers can safely perform office polypectomy for appropriate patients, reducing wait times and healthcare costs. 1