QuizMe 12

Inter-menstrual bleeding

29-year-old woman, gravida 3, para 3, visits the clinic complain of irregular bleeding between her periods. She had her cervical smear test 3 months ago and it was unremarkable.  Upon speculum examination a normal cervix and vaginal mucosa were noted. B-HCG was negative. The patients is interested in future fertility

  • Childbearing age
  • Inter-menstrual bleed
  • Normal cervix,vagina and cervical smear 
  • Endometrial polyp
  • Endometrial hyperplasia/ cancer
  • Fibroids
  • Endometrosis/Adenomyosis

Ultrasonography  (USG)

2 cm Endometrial polyp

  •  Hysterectomy
  •  Operative hysteroscopy
  •  Endometrial ablation
  •  Observation

Operative hysteroscopy

Endometrial polyps are localized hyperplasic overgrowths of endometrial glands and stroma which form projections from the surface of the endometrium.Endometrial polyps are a common finding in gynaecology. Their generally low malignant potential increases with endometrial polyp size, symptoms and patient age.

In the reproductive age group, large or multiple endometrial polyps can contribute to infertility and increase the risk of miscarriage.Endometrial polyps can be diagnosed with ultrasound, saline infusion sonogram or hysteroscopy( which is the gold standard).

Even with low risk of malignant transformation, endometrial polyps warrant hysteroscopic removal under vision which is superior to blind avulsion. Excision allows for both histological diagnosis and effective treatment of abnormal uterine bleeding patterns and excessive menstrual loss.

 

DeWaay et al., observed natural regression of over half of endometrial polyps <1 cmin asymptomatic premenopausal women who underwent Saline infusion sonogram (SIS) with a 2.5 year follow-up, whereas larger endometrial polyps tended to become symptomatic

 

 

  • Jude Annan MRCOG, J., Aquilina FRCOG, J., Ball MRCOG, E., & Ball, E. (2012). The management of endometrial polyps in the 21st century. 14, 33–38. https://doi.org/10.1111/j.1744-4667.2011.00091.x
  • DeWaay DJ, Syrop CH, Nygaard IE, Davis WA, Van Voorhis BJ. Natural history of uterine polyps and leiomyomata. Obstet Gynecol 2002;100:3–7 [http://dx.doi.org/10.1016/S0029-7844(02)02007-0] 
  • Lieng M, Istre O, Qvigstad E. Treatment of endometrial polyps: a systematic review. Acta Obstet Gynecol Scand. 2010 Aug;89(8):992-1002. doi: 10.3109/00016349.2010.493196. PMID: 20528202. 
  • P´erez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005;20:1632–5 [http://dx.doi.org/10.1093/humrep/deh822]
Author

Dr Aya Al-Shati & Dr Mustafa Qasem

Reviewer

Mr Moiad Alazzam