Clinical Scenario

Postmenopausal vaginal bleeding presenting alongside endometrial polyps — a combination that requires careful assessment, as symptomatic postmenopausal bleeding with polyps carries a higher likelihood of associated pathology than in premenopausal women.

Key Clinical Finding

Endometrial polyps are a recognised structural cause of postmenopausal uterine bleeding. Because polyps in symptomatic postmenopausal women are more likely to be associated with malignancy, prompt investigation and definitive management are warranted. Removal of identified polyps is considered a practical step in this context.

Management Approach

The recommended approach involves a hysteroscopic procedure to address the endometrial polyp directly. The full evidence-based regimen — including technique selection and procedural details — is available in the complete protocol.

References

DOI: 10.1016/j.ogrm.2025.09.009

Other causes of PMB include endometrial/cervical polyps, endometrial hyperplasia, exogenous estrogens, atrophic endometritis and vaginitis (Figure 5).
As polyps are more likely to be associated with malignancy in symptomatic postmenopausal women, this also generates anxiety and the need for further investigation and therefore it may be practical to offer removal of any polyps found on USS.
Mechanical hysteroscopic tissue removal is preferred over miniature bipolar electrodes when removing endometrial polyps as it is quicker, less painful and more effective.

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Treatment of Postmenopausal Uterine Bleeding with Endometrial Polyps