Endometrial polyp
ICD-10 N84.0 · ICD-11 GA16.Y

Endometrial Polyp with Abnormal Uterine Bleeding: When Hysteroscopic Polypectomy Has Not Resolved Bleeding

This protocol covers endometrial polyp presenting with abnormal uterine bleeding — premenopausal or postmenopausal — in patients for whom a prior hysteroscopic polypectomy did not achieve resolution of that bleeding.

Clinical Scenario

Symptomatic endometrial polyps with abnormal uterine bleeding require removal. Hysteroscopic polypectomy is the first-line approach and enables histologic assessment; it resolves abnormal uterine bleeding in 75% to 100% of cases. This protocol addresses the minority of patients in whom bleeding persists after polypectomy and further management becomes necessary.

Previous line — goal not achieved Hysteroscopic polypectomy (with histologic assessment) did not achieve its primary target: resolution of abnormal uterine bleeding. The protocol below is the defined next management step after this failure.

Next-Step Approach

A major surgical intervention is available that definitively eliminates both the possibility of polyp recurrence and any residual bleeding risk. It carries substantially greater procedural complexity, cost, and potential for morbidity compared with polypectomy. The complete structured protocol specifies the criteria, decision points, and full clinical pathway.

Full regimen details, selection criteria, and evidence grading are available via the protocol link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jmig.2011.09.003

Symptomatic polyps should be removed in the premenopausal or postmenopausal woman because evidence reports improvement in symptoms, with abnormal uterine bleeding after hysteroscopic polypectomy resolving in 75% to 100% of cases.

Removal for histologic assessment is appropriate in postmenopausal women with symptoms (Level B).

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.

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