Manejo médico prevención de pólipos endometriales

Medical Management: The primary treatment for symptomatic endometrial polyps is hysteroscopic polypectomy, which enables direct visualization and removal of the polyps, preserving endometrial integrity and optimizing clinical outcomes NICE CKSTuncer et al. 2025. This “see-and-treat” outpatient hysteroscopic approach is considered gold standard due to its precision and efficacy in resolving abnormal uterine bleeding associated with polyps NICE CKSWortman 2016. For patients unsuitable or declining surgery, medical therapies such as the levonorgestrel-releasing intrauterine system (LNG-IUS) may be employed, leveraging its local progestogenic effect to induce endometrial atrophy and suppress polyp recurrence Fırtına Tuncer et al. 2025. Oral progestins and combined oral contraceptives are alternative options but have shown less efficacy in preventing recurrence compared with LNG-IUS Tuncer et al. 2025. In selected cases with estrogen-dependent comorbidities like adenomyosis, a brief course of gonadotropin-releasing hormone (GnRH) agonists prior to LNG-IUS insertion may improve symptom control and reduce recurrence risk Tuncer et al. 2025.

Prevention of Recurrence: Regular follow-up after polypectomy is essential, especially in patients with known risk factors such as obesity (BMI ≥30 kg/m2), polycystic ovarian syndrome (PCOS), adenomyosis, uterine leiomyomas, and tamoxifen use, all of which independently increase risk for endometrial polyp recurrence Tuncer et al. 2025. The LNG-IUS has demonstrated a significant 23-fold reduction in recurrence risk compared with oral hormonal treatments or no adjuvant therapy, making it the preferred medical prevention strategy where appropriate Tuncer et al. 2025. Lifestyle modifications targeting obesity and metabolic syndrome may further aid in lowering recurrence risk by reducing unopposed estrogen stimulation, a recognized mechanism driving polyp formation Galani et al. 2025. In women with concurrent adenomyosis or fibroids, thorough preoperative evaluation via transvaginal ultrasound can guide comprehensive management to address coexisting pathologies that may contribute to recurrence risk NICE CKSTuncer et al. 2025.

Summary: Definitive management of endometrial polyps involves hysteroscopic removal. Adjuvant use of LNG-IUS is supported to prevent recurrence, especially in high-risk patients identified by clinical risk factors. Medical therapies such as oral progestins or combined contraceptives can be considered but are less effective for recurrence prevention. Personalized surveillance and lifestyle interventions targeting obesity and hormonal dysregulation complement these approaches. Ongoing research is required to further refine prevention protocols and evaluate novel medical agents.