History

Often an incidental finding during speculum examination.

May cause PMB, IMB, PCB, unscheduled bleeding on HRT, discharge. See Out of Scope for separate guidance.

Examination

On speculum examination, assess the polyp. A cervical smear can generally still be obtained if it is due.

If it is a fungating/suspicious mass, then a referral should be made on the Urgent Suspected Gynaecological Cancer Pathway (USCP).

If the base of the polyp cannot be seen it could be an endometrial polyp – refer routinely to Gynaecology and request a transvaginal ultrasound scan (TVUSS).

Differential Diagnosis

• Endometrial polyp
• Cervical malignancy

• Suspicious looking cervix - possible cervical cancer e.g. fungating mass - refer on Urgent Suspected Gynaecological Cancer Pathway (USCP) Gynaecology - South & West 

• Investigations will depend on the symptoms – see Out of Scope for links to guidance on management of PMB, unscheduled bleeding on HRT, IMB, PCB and vaginal discharge.
• If an endometrial polyp is suspected, then refer routinely to Gynaecology and request a transvaginal ultrasound scan (TVUSS).

Asymptomatic polyps:

• If asymptomatic the risk of malignant change is so small you can offer the woman a choice of removal or monitoring. If this remains asymptomatic then no further assessment is required.

Symptomatic polyps:

• Should be removed due to the small risk of malignancy. Refer routinely to Gynaecology or consider removal in general practice if there is an appropriately trained and skilled clinician willing to undertake the procedure. Removal of polyps is a painless procedure. Polyps should be sent off for histological examination. Do not remove if patient is pregnant (risk of miscarriage).

Technique for removal of cervical polyp:

1. Gain verbal consent.

2. Routine speculum examination.

3. Grasp polyp at base using sponge-holding forceps, twist clockwise with gentle traction (several 360-degree twists may be required) until it falls off. (If only partially removed, continue and act based on ongoing symptoms and results of histopathology)

4. Apply silver nitrate to base using a 75% caustic applicator (generally not necessary, however this can reduce bleeding and risk of infection).

5. Send the polyp off for histology.

Advise the patient that she may experience light bleeding and mild period cramps for up to 24hrs after removal. She may also get some grey/brown coloured discharge for a couple of days.

Outcome Based on histology:

• if it is a normal benign cervical polyp no further action is required.
• If it is found to be an endometrial polyp, a TVUSS needs to be requested to check for other endometrial polyps. If there are more present the patient will require routine referral to Gynaecology.

Urgent Suspected Gynaecological Cancer Pathway (USCP)

Suspicious looking cervix - possible cervical cancer e.g. fungating mass - refer Urgent Suspected Gynaecological Cancer Pathway (USCP) Gynaecology - South & West 

Routine Referral Criteria

1) Symptomatic polyp and removal in primary care impracticable

2) The base of the polyp is not visible (could be a prolapsed endometrial polyp) - refer routinely to Gynaecology and request a transvaginal ultrasound scan (TVUSS)

3) The polyp is greater than1cm wide

4) Confirmed endometrial polyp (on TVUSS)

Information to include in referral letter:

• Any current hormonal treatment
• Smear history (including last smear result)
• Relevant past medical/surgical history
• Current regular medication and allergies
• Investigations prior to Referral and Cervical smear (if due)

Referral Instructions

e-Referral Service Selection

Specialty: Gynaecology

Clinic Type: Not otherwise specified

Service: DRSS-Western-Gynaecology-Devon ICB-15N

Referral Form

DRSS Referral Form

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: December 24