NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)
Cervical polyp, a common benign growth causing spotting or postcoital bleeding; the GP recognises it on speculum exam and refers for outpatient removal and histology to exclude malignancy. - Refer, with advice
Children follow the same pathway: recognise and refer. No primary-care medicine is implied.
No dose - referral pathway, no medicine given in primary care
Cervical polyp, a common benign growth causing spotting or postcoital bleeding; the GP recognises it on speculum exam and refers for outpatient removal and histology to exclude malignancy.
- No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
- RED FLAG - Do not attempt to remove a polyp you cannot see clearly; blind removal from the cervical canal or uterine cavity risks uterine perforation. Only easily visible polyps belong in an outpatient setting.
- In a postmenopausal woman, or where polyps recur, the cervical canal and uterine cavity must be examined by hysteroscopy to exclude endometrial polyps or malignancy.
- Up to a quarter of women with a cervical polyp also have an endometrial polyp, so a cervical polyp is not a reason to stop looking.
- Among women who are symptomatic, up to 5% of polyps turn out to be precancerous or cancerous.
- Arrange endometrial sampling where indicated, alongside a triple (vaginal-cervical-endocervical) smear and transvaginal ultrasound.
- In pregnancy, removal of a cervical polyp is generally deferred unless complications arise, because of the risk of bleeding and infection.
- In a pregnant woman with recurrent unexplained bleeding, colour Doppler ultrasound is recommended to identify an endocervical polyp and to exclude other causes such as vasa praevia. Bleeding from a polyp can otherwise be mistaken for an inevitable miscarriage.
- Cervical polyps are vascular, and bleeding in the postpartum period can be a significant complication.
- A large polyp that blocks the cervical canal can cause infertility.
- A polyp that becomes inflamed or infected presents with a yellowish vaginal discharge.
- RED FLAG - Heavy or persistent bleeding, bleeding after the menopause, or a polyp with an atypical or friable appearance: refer.