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How should I manage cervical polyps?

Q - What is the best way to manage cervical polyps noted incidentally at routine smear tests?

A - Cervical polyp is a relatively common finding in women having a routine smear test. If the polyp is small, the GP should remove it and send it for histology. The vast majority of these polyps are benign and only 1.7 per cent are malignant.

Cervical polyps are also associated with the presence of endometrial polyps in 27 per cent of cases. This incidence is much higher (57 per cent) in postmenopausal women and lower (8 per cent) in women taking the combined oral contraceptive pill. Therefore, a further investigation with ultrasound scan and/or hysteroscopy is necessary, especially in postmenopausal women presenting with a cervical polyp.

If the polyp is larger than 1cm diameter or if the above investigations (histology, ultrasound) are not available, patient should be referred to a gynaecologist.

In summary, cervical polyps noted incidentally at routine smear tests must be removed and sent for histology to rule out malignancy. Further assessment of the endometrial cavity by ultrasound scan or hysteroscopy is necessary.

Mr Narendra Pisal and

Dr M Sindos, Department of Women's Health, Whittington Hospital, London

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