The role of hysteroscopy in the current management of the cervical polyps

Abstract

The current management of patients with cervical polyps may include different approaches and protocols, such as a simply removal of the polyp in most cases at an office setting, surgical dilatation and curettage, electrosurgical excision or hysteroscopic polypectomy. Exploration of the cervical canal and uterine cavity by hysteroscopy determines the exact origin of the polyp pedicle (cervical or endometrial) and if there is any concurrent endometrial pathology. The majority of cervical polyps are asymptomatic, and their incidence is increasing with age. Symptomatic cervical polyps may cause intermenstrual bleeding, postcoital bleeding, heavy menses, postmenopausal bleeding and vaginal discharge. Cervical polyps may be detected by routine gynaecological examination, colposcopy, filling defects on hysterosalpingogram, gynaecological ultrasound (abdominal, transvaginal or sonohysterography) or endometrial biopsy. The location, number, and size of cervical polyps are best determined with diagnostic hysteroscopy. In the past, simple twisting or avulsion of the polyp or blind curettage was the standard surgical treatment of choice. However, this treatment often leaves residual polyp fragments in the cervical canal. Difficulty may also occur in differentiating endocervical from endometrial lesions. In addition, up to 25% of patients who have cervical polyp, have also a coexisting endometrial polyp, so there is a need for evaluation of the endometrial cavity. It is important to note the usefulness of hysteroscopy to manage a patient with a cervical polyp, especially when she presents abnormal uterine bleeding, in order to make an accurate diagnosis and offer appropriate treatment.

Macrophages in patients with recurrent endometrial polyps could exacerbate Th17 responses

“…Previous studies have associated EP with suboptimal fertility . Removal of EP by hysteroscopic polypectomy in previously infertile women appears to allow pregnancy and improve their fertility, but the reasons for the effectiveness of this procedure are not completely clear . Interestingly, a number of studies indicate that inflammation due to infections or lack of fetal tolerance is associated with pregnancy loss .…”

CD4+ T cell imbalance is associated with recurrent endometrial polyps

“…The occurrence of EP increases with advancing age and obesity, but no direct cause is known. In women with difficulty to conceive or suffering recurrent miscarriages, hysteroscopic polypectomy can be performed to remove the polyps, which seems to improve fertility . However, depending on the duration of the follow‐ups and the nature of the EP, 2.5%‐43.6% of patients present postoperative EP recurrence .…”

Clinical parameters associated with unsatisfactory specimens of conventional cervical smears

“…17 Endocervical polyps are a focal hyperplasia of the glandular epithelium of the endocervix that contains a glandular structure with a fibrous core. 18 The etiologies of endocervical polyps are not fully understood. Chronic inflammation, abnormal local responsiveness to hormonal stimulation, and localized vascular congestion are possible causes.…”