.Endometrial polyp
1-common finding in patients with infertility and abnormal uterine bleeding
2- diagnosis ( best time In the proliferative/follicular phase) by
a - 2 D ultrasound ( appears as a hyperechoic lesion )
b - if you add Doppler you will see single feeding vessel
c by 3D ultrasound
d- by 2d Saline infusion sonohysterography
e - by 3D SIS
f- hysteroscopy ( the gold standard )
3- blind dilatation and curettage or biopsy should not be used for diagnosis or treatment of endometrial polyp
4-treatment by hysterscopic polypectomy
Summary of the AAGL Practice Report: Practice Guidelines for the Diagnosis and Management of Endometrial Polyps 2012
Guidelines for Recognizing the Presence of Endometrial
Polyps
- Increasing age is the most common risk factor for the
presentation of an endometrial polyp (Level B)
-
For women with symptoms with a polyp, abnormal uterine bleeding is the most common presenting symptom (Level B).
-
Infertile women are more likely to be diagnosed with an endometrial polyp (Level B).
-
Polyps may naturally regress in up to 25% of patients,
with small polyps more likely to resolve spontaneously
(Level A).
- Medications such as tamoxifen may predispose to the
formation of endometrial polyps (Level B).
Guidelines for the Diagnosis of Endometrial Polyps
- TVUS provides reliable information for the detection of
endometrial polyps and should be the investigation of
choice where available (Level B).
-
The addition of color or power Doppler increases the capacity of TVUS to diagnose endometrial polyps (Level B).
-
Adding intrauterine contrast to sonography (with or without 3-D imaging) improves the diagnostic capacity for endometrial polyps (Level B).
-
Blind dilation and curettage or biopsy should not be used for diagnosis of endometrial polyps (Level B).
Guidelines for the Management of Endometrial Polyps
-
Conservative management is reasonable, particularly for small polyps and if asymptomatic (Level A).
-
Medical management of polyps cannot be recommended at this time (Level B).
-
Hysteroscopic polypectomy remains the gold standard for treatment (Level B).
-
There does not appear to be differences in clinical outcomes with different hysteroscopic polypectomy techniques (Level C).
-
Removal for histologic assessment is appropriate in postmenopausal women with symptoms (Level B).
-
Hysteroscopic removal is to be preferred to hysterectomy because of its less-invasive nature, lower cost, and reduced risk to the patient (Level C).
For the infertile patient with a polyp, surgical removal is
recommended to allow natural conception or assisted reproductive technology a greater opportunity to be successful (Level A).