Endocervical Polyps DO Cause Abnormal Uterine Bleeding
Endocervical polyps are a well-established cause of abnormal uterine bleeding in premenopausal women, commonly presenting with intermittent spotting, postcoital bleeding, and intermenstrual bleeding. 1, 2
Clinical Presentation
- Symptomatic cervical polyps characteristically cause intermenstrual bleeding, postcoital bleeding, heavy menses, and vaginal discharge in women of reproductive age 1
- Cervical polyps are included in the differential diagnosis of abnormal uterine bleeding as an organic reproductive tract disorder, alongside endometrial polyps, submucous leiomyomas, and cervical erosion 3
- The majority of cervical polyps are asymptomatic and their incidence increases with age, but when symptomatic, bleeding is the predominant manifestation 1
Diagnostic Approach
- Transvaginal ultrasound combined with transabdominal imaging is the recommended first-line diagnostic test to identify structural causes of abnormal uterine bleeding, including cervical polyps 4, 5
- Cervical polyps may be detected by routine gynecological examination, colposcopy, transvaginal ultrasound, or sonohysterography 1
- Hysteroscopy is the gold standard for determining the exact origin of the polyp pedicle (cervical versus endometrial) and for detecting concurrent endometrial pathology, which coexists in up to 25% of patients with cervical polyps 1
Critical Diagnostic Pitfall
- Up to 25% of patients with a cervical polyp have a coexisting endometrial polyp, making evaluation of the endometrial cavity essential when abnormal bleeding is present 1
- Simple removal of the visible cervical polyp without endometrial cavity assessment may miss concurrent endometrial pathology that is contributing to the bleeding 1
- In premenopausal women, endometrial thickness on ultrasound is not a reliable indicator of pathology—endometrial polyps may be present even with thickness <5 mm 5
Management Algorithm
- When a premenopausal woman presents with intermittent spotting and a cervical polyp is identified, perform transvaginal ultrasound to assess the endometrial cavity for concurrent pathology 4, 5
- If ultrasound suggests intracavitary lesions or findings are unclear, proceed to saline infusion sonohysterography, which has 96-100% sensitivity for detecting endometrial pathology 5, 6
- Hysteroscopic polypectomy is the recommended surgical treatment, allowing complete polyp removal under direct visualization and simultaneous evaluation of the endometrial cavity for coexisting lesions 1, 2
- Avoid simple twisting or avulsion of the polyp, as this often leaves residual polyp fragments in the cervical canal 1
Evidence Strength
The association between cervical polyps and abnormal uterine bleeding is supported by multiple high-quality sources. The American College of Radiology guidelines 7 and comprehensive reviews 1, 2, 3 consistently identify cervical polyps as a structural cause of abnormal bleeding. The recommendation for hysteroscopic evaluation is particularly strong given the high rate (25%) of concurrent endometrial pathology 1.