When Should Endometrial Polyps Be Treated?

SAGE Open Medicine

Endometrial polyps are overgrowths of endometrial glands that typically protrude into the uterine cavity. Endometrial polyps are benign in nature and affect both reproductive age and postmenopausal women. Although endometrial polyps are relatively common and may be accompanied by abnormally heavy bleeding at menstruation. In asymptomatic women, endometrial polyps may regress spontaneously, in symptomatic women endometrial polyps can be treated safely and efficiently with hysteroscopic excision.

Reviews in Gynaecological Practice, 2004

Endometrial polyps are common, increasing in incidence with age. They are also commoner in women with obesity and hypertension, and those treated with tamoxifen. They can be asymptomatic or can be associated with abnormal uterine bleeding. Diagnosis can be made with ultrasound or hysterosonography, but diagnostic hysteroscopy remains the gold standard is as it allows assessment of the rest of the uterine cavity. Although the risk of malignant transformation is low, the general consensus is that polyps should be removed. The most widely recommended method of removal is hysteroscopic resection. Long term follow up studies have shown that after polypectomy, symptomatic relief is greater in the older age group, so a causative role of polyps in abnormal uterine bleeding in younger women is questionable.

The Obstetrician & Gynaecologist, 2012

Journal of Minimally Invasive Gynecology, 2009

To estimate the prevalence, 1-year regression rate, and clinical significance of endometrial polyps in women aged 45 to 50 years. Design: Cross-sectional study (Canadian Task Force II-2). Setting: University teaching hospital. Patients: Two hundred fifty-seven of 1000 randomly selected women aged 45 to 50 years. Interventions: Transvaginal ultrasonography and saline infusion sonography were performed in all study participants and were repeated in women with endometrial polyps after 12 months. Polyps present at follow-up were removed by hysteroscopic polyp resection. Measurements and Main Results: Endometrial polyps were diagnosed in 31 women (12.1%). At 1 year, the polyp regression rate was 27%. Myomas occurred more often in women with endometrial polyps, and women with polyps experienced significantly heavier periodic bleeding compared with women without polyps. Conclusion: Our study findings suggest that endometrial polyps are common in women aged 45 to 50 years and that women with such polyps experience heavier periodic bleeding. Although some polyps seem to regress spontaneously during 1-year follow-up, most seem to persist.

2017

Endometrial polyps are one of the most common etiologies of abnormal genital bleeding in both premenopausal and postmenopausal women. They are hyperplastic overgrowths of endometrial glands and stroma that form a projection from the surface of the endometrium. They may also be asymptomatic. The great majority of endometrial polyps are benign, but malignancy occurs in some women. Single or multiple polyps may occur and range in diameter from a few millimeters to several centimeters. Giant endometrial polyps associated with tamoxifen and raloxifene use. Here we presented a giant endometrial polyp in a postmenopausal woman without any complaints and hormone or drug use.

Acta Obstetricia et Gynecologica Scandinavica, 2010

Background. Transcervical resection of endometrial polyps is usually performed in order to exclude atypic and/or malignant endometrial changes, to relieve abnormal uterine bleeding or to improve infertility. Objective. To systematically explore the rationale of transcervical polyp resection. Search strategy. Electronic searches of MEDLINE, EMBASE and The Cochrane Library. Selection criteria. Studies reporting the prevalence of premalignant and/or malignant tissue changes within endometrial polyps, as well as outcomes of endometrial polyp removal in terms of symptom relief and improved fertility were included. Main results. 46 studies met the criteria for inclusion (malignancy: 20 studies including 9,266 women, symptom relief: 15 studies including 1,034 women, infertility: 11 studies including 935 women). Most studies were uncontrolled retrospective case series. Only two randomized controlled trials were identified. The prevalence of premalignant and malignant tissue changes within endometrial polyps varied in the included studies, 0.2-23.8% and 0-12.9%, respectively. Postmenopausal symptomatic women appeared to have the highest risk of premalignant and malignant tissue changes. The effect of polypectomy on periodic blood loss appeared to be questionable, but all studies measuring the effect of polypectomy by general terms such as improved/not improved reported a favorable outcome (75-100% success rate). Polypectomy appears to have a favorable outcome in infertile women. Conclusions. The evidence which substantiates the removal of endometrial polyps is limited, and future research evaluating the outcome of this common procedure is required. Based on the available evidence, however, we provide recommendations for treatment of women with endometrial polyps.

Archives of Gynecology and Obstetrics, 2015

Purpose To determine the prevalence of malignant and premalignant endometrial polyps and to investigate the association of malignancy with specific factors. Methods This is a retrospective study of women submitted to hysteroscopic resection of endometrial polyps between January 2005 and July 2013 at a university hospital in southern Brazil. Data regarding clinical characteristics and pathology findings were collected from patient charts. Results Of 359 patients, 87.2 % had benign polyps and 9.9 % had hyperplasia without atypia. Atypical hyperplasia was found in 2.6 % of the sample. Endometrial adenocarcinoma was found in one woman (0.3 %). A correlation was observed between malignant/premalignant polyps and patient age, menopausal status, and uterine bleeding. All patients with malignancies/premalignancies had abnormal uterine bleeding. Higher frequency of malignant polyps was observed in tamoxifen users, however, without statistical significance (p = 0.059 %). Malignancy was not correlated with arterial hypertension, diabetes mellitus, obesity, hormone therapy, endometrial thickness, and polyp diameter. Conclusions Malignant/premalignant findings had low prevalence and were absent in asymptomatic patients. From the data of this retrospective study, it is unclear whether routine polypectomy should be performed in asymptomatic patients. Further prospective studies including larger numbers of patients are required to guide treatment recommendations.

Ultrasound in Obstetrics and Gynecology, 2001

Purpose: To evaluate the efficiency of transvaginal ultrasound in the early diagnosis of ovarian cancer. Methods: Screening transvaginal ultrasound has been annually performed during the last 2 years in asymptomatic women without familial history of ovarian cancer. When abnormalities were detected, the procedure was repeated after 4-6 weeks. If the findings disappeared, the study was repeated after 1 year. If the abnormality persisted, study was complemented with tumor markers, computed tomography and laparoscopic surgery. The findings were compared with a control group of women in whom ovarian transvaginal ultrasonography was formally indicated. Results: A total of 26007 transvaginal ultrasound were performed: 8813 (33.8%) belonged to the screening group and 17194 (66.2%) to the control group. In 14 patients of the screening group, a malignant tumor was diagnosed and histologically confirmed. The mean age of these patients was 45 years old (SD 12). Eleven of these tumors were stage I (seven Ia, and four Ic), two stage IIIc and one was a metastatic melanoma in both ovaries. Six lesions were borderline tumors (five serous and one mucinous). In the control group, 27 ovarian cancers were diagnosed in patients with a mean age of 48 years (SD 17). In this group, 11 tumors were in stage I, and six were borderline. Conclusions: Although consensus about the benefits of using transvaginal ultrasound as a screening procedure is not conclusive, our data reveals that tumors detected in patients screened with transvaginal ultrasound are in earlier stages when compared with those diagnosed in the control group. No differences were found in age and number of borderline tumors between both groups. Additional studies are needed to support this preliminary findings.

Hysteroscopy Simplified by Masters, 2020

Endometrial polyps are exophytic growths of the mucous linings of the endometrium. They differ in size, shape, number and appearances. The surface epithelium of the polyp is smooth and similar to surrounding epithelium. They differ from pedunculated fibroids in the manner of surface epithelium and vascularity through the peduncle along with the surface of the growth. Polyps can be associated with glandular hyperplasia and can remain latent for a longer period of time. Grossly, they are pink-grey to white in colour, with smooth and glistening surface. The tip or the entire polyp can be haemorrhagic. Found mostly in fundal or cornual regions, polyps range from millimetres in size to those that occupy the whole uterine cavity. Some other intrauterine pathologies like endometrial hyperplasia, sarcoma or even carcinoma may show polypoid appearance. The impact of polyps on infertility mainly depends upon its size and location. Depending upon their location, they may cause mechanical obstruction (e.g. tubocornual polyp), by their association with endometriosis or by the expression of enzyme aromatase. Polyp removal appeared to improve fertility and increase pregnancy rates in previous infertile women with no other reason to explain their infertility, regardless of the size and number of their polyps.

Acta Obstetricia et Gynecologica Scandinavica, 2000

Background. To characterize postmenopausal women with endometrial polyps and to evaluate their significance. Methods. The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings. Results. Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p∞0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories. Conclusions. Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.