Key content
Hysteroscopic endometrial polyp removal appears to be superior to the current practice of blind avulsion.
Outpatient treatment is safe, cost effective and well tolerated, even in older or nulliparous women.
New technologies facilitate office hysteroscopy.
Benign endometrial polyps can regress and rarely progress to malignancy.
Learning objectives
To learn how to diagnose and treat endometrial polyps in pre and postmenopausal women.
To be able to compare the performance of diagnostic modalities.
To understand the role of outpatient vaginoscopy and hysteroscopy.
Ethical issues
Given the cost effectiveness and acceptability of office ambulatory diagnostic and interventional hysteroscopy, is it ethical not to offer such a service?
Keywords cost effectiveness / infertility / malignancy / outpatient hysteroscopy / ultrasonography
Introduction
Aetiology and presentation
Epidemiology and risk factors
Malignant endometrial polyps
Endometrial polyps and fertility
Diagnostic modalities
Treatment of endometrial polyps
Hysteroscopic resection
Conclusion
Endometrial polyps are a common finding in gynaecology.Their generally low malignant potential increases with endometrial polyp size, symptoms and patient age. These factors need to be taken into account when considering treatment options . Incidental small endometrial polyps in premenopausal women may be amenable to conservative treatment due to their low malignant potential
and chances of regression. However, endometrial polyps that lead to infertility, postmenopausal bleeding, menorrhagia and abnormal bleeding patterns and those in postmenopausal women warrant hysteroscopic removal under vision, which is superior to blind avulsion. Adequate patient selection, psychological support, a competent operator and a setting that
creates a private, caring and calm environment are prerequisites
for carrying out this procedure in the outpatient setting.