This protocol addresses the clinical scenario of a small endometrial polyp — measuring less than 10 mm — discovered incidentally in a patient with no abnormal uterine bleeding and no related symptoms.
The patient has a confirmed endometrial polyp that is asymptomatic, with an absence of abnormal uterine bleeding, and polyp size below 10 mm. In this population, conservative management is reasonable given evidence that a meaningful proportion of small polyps may regress spontaneously — and that the malignant risk in asymptomatic cases is low.
DOI: 10.1016/j.jmig.2011.09.003
Conservative management is reasonable, particularly for small polyps and if asymptomatic (Level A).
There is Class II evidence that polyps may spontaneously regress in approximately 25% of cases, with smaller polyps more likely to regress compared with polyps .10 mm in length.
Asymptomatic postmenopausal polyps are unlikely to be malignant and observation is an option after discussion with the patient.
Hysterectomy guarantees no polyp recurrence and no potential for malignancy; however, it is a major surgical procedure, with significantly greater costs and potential for morbidity.