Obstetrics & gynaecology
AKT · Obstetrics & gynaecology/Menstrual & benign gynaelow yield
Cervical ectropion
Columnar epithelium on the ectocervix (oestrogen effect)
Overview
A benign extension of endocervical columnar epithelium onto the ectocervix, exposed to the vaginal environment — common in young women, on the COCP and in pregnancy (high oestrogen). Causes post-coital bleeding and discharge.
Recognise
- Post-coital bleeding, intermenstrual bleeding, increased non-offensive discharge
- Red velvety area around the os on speculum
- Associated with high oestrogen states (COCP, pregnancy, adolescence)
Red flags
- Post-coital bleeding ALWAYS needs cervical cancer excluded first
Differentials & how to tell them apart
Cervical cancerthe must-exclude cause of post-coital bleeding — irregular friable lesion, biopsy
Cervicitis (chlamydia/gonorrhoea)infective, discharge, NAAT positive
Cervical polyppedunculated lesion
Investigations
Speculum exam; ensure cervical screening is up to date and EXCLUDE cervical cancer and infection (chlamydia) before attributing bleeding to ectropion.
Management
Reassurance (asymptomatic); ablation only if symptomatic and cancer excluded
- 1Asymptomatic: no treatment. Confirm normal screening and exclude infection/cancer.Gate: Treat (ablation) only once cervical cancer and infection are excluded
- 2Troublesome bleeding/discharge: consider stopping oestrogen-containing contraception or ablation.
Stop oestrogen (change contraception) — often resolves
Ablation (cryotherapy/diathermy) — if troublesome and cancer excluded
Key points
Benign — but post-coital bleeding must always trigger exclusion of cervical cancer first.
Monitor & prognosis
Symptom resolution; screening up to date.
Benign; often resolves with lower oestrogen.
Source: NICE CKS