Endometrial Polyps – Do They Always Need To Be Removed?
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
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
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.
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
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.
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
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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.
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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