Expectant management is reasonable for a small, asymptomatic polyp in a premenopausal patient, provided the imaging is not suspicious and follow-up is reliable. Up to approximately 25% of polyps regress spontaneously, with regression more likely when the lesion is smaller than 10 mm. Observation is not the same as ignoring the lesion: the patient needs a plan for reassessment and clear instructions to report new or worsening bleeding. Hysteroscopic polypectomy is preferred when the patient has abnormal bleeding, when a postmenopausal patient is symptomatic, when infertility is being evaluated, or when the lesion persists or appears suspicious. In infertile patients, removal improves fertility outcomes and is recommended before or during fertility treatment. The tissue should be sent for pathology even when the visual appearance is reassuring. Blind curettage is inferior when hysteroscopically guided removal is available. Curettage can fail to remove a focal lesion and provides less reliable targeting. Direct visualization allows the clinician to identify the attachment, remove the polyp more completely, and obtain tissue from the actual abnormality. Medical therapy may reduce bleeding symptoms, but it is not...