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CMECNE

Endometrial Polyps – Do They Always Need To Be Removed?

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Name the imaging tests for identifying polyps
2. List the factors associated with malignancy

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Endometrial polyps are a common cause of menstrual abnormalities and postmenopausal bleeding, with a prevalence of 7.8-35% depending on the population studied.

  • To diagnose polyps, transvaginal ultrasound is reliable and can be augmented by saline infusion sonohysterography
    • Addition of color Doppler is sometimes helpful in identifying a feeding vessel
  • Consider annual observation if polyp is < 10 mm, as up to 25% of polyps will resolve spontaneously
  • Hysteroscopy with resection under direct vision is effective and reduces recurrence rate
  • Blind dilation and curettage or biopsy should not be used for the diagnosis of polyps

SYNOPSIS:

Although uncommon, both endometrial hyperplasia and endometrial cancer can occur in polyps. When symptomatic, premenopausal women present with abnormal uterine bleeding (AUB-P), and postmenopausal women may have postmenopausal bleeding. Prevalence appears to be higher in women seeking fertility treatment but cause and effect have yet to be established. It is important to know when to intervene and when to observe.

KEY POINTS:

  • Risk of malignancy increases with age and size of the polyp with the highest rates in postmenopausal women with bleeding
    • However, asymptomatic polyps in postmenopause are not likely to be malignant
    • Observation is an option following discussion of risk/benefit with the patient
  • Malignancy is unlikely in premenopausal women even if symptomatic
  • Women on tamoxifen (a SERM) are at increased risk for the development of polyps
  • Polypectomy in subfertile women appears to improve fertility
    • Recurrence rate is 2.5-3.7% up to 9 years after resection

Learn More – Primary Sources:

AAGL Practice Report: Practice Guidelines for the Diagnosis and Treatment of Endometrial Polyps

Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review

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Related ObG Topics:

Endometrial Hyperplasia – Current Nomenclature and Treatment
Ovarian or Endometrial Cancer? Consider Lynch Syndrome
Endometrial Cancer: The Basics
How Well Does Sonohysterography Match Up Against the Gold Standard of Hysteroscopy?
AAGL and “Choosing Wisely”: Five Practices to Question
Tamoxifen Therapy and Uterine Cancer Risk: The Data and Clinical Implications

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OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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