CERVICAL
POLYPS
Pharm. Emaediong Emmanuel
OVERVIEW
◦ THE CERVIX
◦ CERVICAL POLYPS
◦ ETIOLOGY
◦ EPIDEMIOLOGY
◦ PATHOPHYSIOLOGY
◦ SIGNS AND SYMPTOMS
◦ RISK FACTOR
◦ DIAGNOSIS
◦ DIFFERENTIAL DIAGNOSIS
◦ COMPLICATIONS
◦ MANAGEMENT
◦ CASE STUDY
◦ CONCLUSION
◦ REFERENCES
THE CERVIX
CERVICAL POLYPS
◦ Cervical polyps are benign growths, usually protruding from the
surface of the cervical canal commonly occuring during the
reproductive years.
◦ They may vary in size (usually >3cm in diameter), shape, and
origin and can present as single or multiple, tear-shaped or lobular,
cherry-red, or greyish-white in colour
◦ Cervical polyps are categorized depending on their origin;
◦ Endocervical polyps; arise from the cervical glands in the
endocervix (Premenopausal women).
◦ Ectocervical polyps; arise from the outer surface layer cells of the
cervix within the ectocervix (Post menopausal women).
◦ The etiology of cervical polyps
remains unknown. But many
theories have been identified.
1. Congestion of cervical blood
vessels.
ETIOLOGY 2. Inflammation of the cervix which
may be caused by an infection.
3. In some women, there is abnormal
response to the increase in
estrogen levels causing excessive
growth of the cervical tissue
(hyperplasia).
EPIDEMIOLOGY
◦ In the general population,
the estimated prevalence
of cervical polyps is
between 2-5% in women.
◦ Multigravida women have
an increased risk of
developing cervical polyps
compared to nulliparous.
◦ Cervical polyps develops as a result
of focal hyperplasia of the columnar
PATHOPHYSIOLOGY
epithelium of the endocervix or
extocervix.
SIGNS AND SYMPTOMS
Periods that are
Post coital Bleeding after
heavier than
bleeding menopause
usual.
Vaginal
Bleeding discharge which Yellowish
between periods may have a foul discharge
smell
◦ Women with
poor vaginal
hygiene
◦ Multigravida
women
◦ Certain
infections
(STIs)
◦ History of
abortion
◦ Increased level
of oestrogen
◦ Inflammation
DIAGNOSIS
◦ Routine pelvic examination
◦ Pap Smear test
◦ Biopsy
DIFFERENTIAL
DIAGNOSIS
◦ Endometrial
polyps
◦ Uterine
fibroid
◦ Pedunculated
polyp
◦ Sessile polyp
◦ Surface
lesions of the
genital tract
COMPLICATIONS
Haemorrhage
Infertility
Infection
Malignancy (rarely)
MANAGEMENT
◦ Can be removed through polypectomy
◦ Symptomatic management
1. For pains, mild pain relief e.g Diclofenac, PCM, Ibuprofen
2. For infections; Antibiotics
CASE STUDY
◦ Patient E.K., is a 36 year old, P5+0 woman who presented to the hospital
on 19/04/2021 with history of:
1. Vaginal protrusion * 1/52
2. Vaginal discharge * 1/52
3. Lower abdominal pain * 1/52
4. Deep dyspareunia
◦ The protrusion returns spontaneously.
◦ She went to a peripheral centre in town and was verbally referred to the
facility.
◦ Gynae Hx: LMP=22/03/2021 K=5/28-30 Normal Flow
◦ O/E: not in obvious distress, not pale, afebrile, anicteric, acyanosed, no
dehydration, no pedal oedema.
◦ Vitals: BP: 120/80mmHg; P=84b/m (60-100b/m)
◦ V/E: Poor vulval hygiene with draining of creamy/brownish coloured
effluent, foul smelling and protrusion of part of the uterus on bearing
down. It is said to be itching, after ingestion of herbal concoction due to
dysmenorrhea
◦ Ass: Utero-vaginal Prolapse
◦ Plan: Refer to the Gynae clinic immediately for further investigations.
◦ PMHx; H0 E0 A0 D0 S0
◦ Drug Hx: Not on any routine drugs
◦ FS Hx: Patient is married with 5 Children (3M, 2F) in a monogamous
setting.
◦ Speculum: Normal looking cervix with protrusion from the external os.
◦ Digital: Firm smooth mass noted in to vaginal vault protruding from the
cervix
? Cervical polyps to rule out elongated cervix
Abdomino-pelvic mass to exclude uterine fibroids
Plan: Run tests for the following and return for review in 1/52
1. Abdomino-pelvic US
2. ECS
3. Urine M/C/S
4. Urinalysis
5. E/U/Cr
LABORATORY INVESTIGATIONS
TESTS RESULTS
Urine M/C/S Yielded no bacterial growth after 24 hours of incubation
Abdomino-pelvic Bulky cervix with an oval shaped mass attached at the
US fundus by a stalk measuring 3.8cm. Features suggestive of
Cystitis and Cervical Polyps.
ECS Yielded growth of S. aureus
Urinalysis Normal
E/U/Cr Sodium----143.1mmol/L (136-145)
Potassium 4.3mmol/L(3.5-5.1)
Chloride 108.9mmol/L (98-107)
Bicarbonate 25.0mmol/L (22-28)
Urea 3.3mmol/L (2.5-9.1)
Creatinine 78.7mmol/L (67-114)
◦ On presentation with the laboratory results and review, patient E.K.,
was diagnosed with Cervical Polyps.
◦ The patient was contacted and instructed to come back 1st week of
June for Polypectomy with symptomatic management of pain and
infection using:
1. Tab Diclofenac 50mg i bd *10/7
2. Tab Ampiclox 500mg tds * 5/7
CONCLUSION
◦ Cervical polyps still represent a modifiable risk for women of
childbearing age.
◦ Most cases of cervical polyps are not possible to prevent.
◦ However, having regular pelvic examinations and Pap smear tests
should ensure that doctors can catch any polyp and treat them early
on.
◦ It is possible that some infections could contribute to cervical
polyps developing. Due to this, practicing safe sex and proper
hygiene to avoid infection may also help to prevent cervical polyps.
◦ Pharmacists must be versed in these preventive measures as well as
educate their patients & more importantly, play their role in
medication management.
REFERENCES
◦ TeachMeObGyn. 2021. Cervical Polyps - Causes - Symptoms - Management -
TeachMeObGyn. [online] Available at:
[Link]
◦ Tanos, V., Berry, K., Seikkula, J., Abi Raad, E., Stavroulis, A., Sleiman, Z.,
Campo, R. and Gordts, S., 2017. The management of polyps in female
reproductive organs. International Journal of Surgery, 43, pp.7-16.
◦ Nelson, A., Papa, R. and Ritche, J., 2021. Asymptomatic Cervical Polyps: Can
We Just Let them Be? - Anita L Nelson, Rhett R Papa, Julia J Ritchie, 2015.
[online] SAGE Journals. Available at: [Link]
◦ Kilpatrick, C., 2021. Cervical Polyps - Gynecology and Obstetrics - MSD
Manual Professional Edition. [online] MSD Manual Professional Edition.
Available at:
[Link]
aneous-gynecologic-disorders/cervical-polyps
