Giant endometrial polyp in postmenopausal women without hormonal exposure: a case report and literature review

Objective: Giant endometrial polyps (EPs) are rare in postmenopausal women without hormonal exposure. This study aimed to summarize their clinical presentation and management. Patient: Fifteen postmenopausal women with primary giant EPs were included: one case from our center and fourteen additional cases were retrieved from Pubmed, Web of science and Embase databases. Results: The fifteen patients ranged in age from 55 to 70 years, with polyp diameters ranging from 4.0 to 12.0 cm. The most common symptom was postmenopausal bleeding (PMB). Surgical intervention was performed in all cases: six patients underwent hysteroscopic polypectomy, eight received total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and one underwent dilation and curettage D&C. Most polyps (11/15) were benign on histology and exhibited cystic dilatation. Conclusion: Giant EPs in postmenopausal women are rare but predominantly benign, especially in the absence of hormonal exposure. Transvaginal sonography (TVS) is the first-line modality for initial evaluation. Diagnostic hysteroscopy with complete polypectomy remains the gold standard, enabling accurate histopathological assessment and avoiding unnecessary hysterectomy.