Treatment of endometrial polyps: a systematic review

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

BMC Women's Health, 2015

Background: The objectives of this study were to determine the effectiveness the effectiveness of post-polypectomy hysteroscopic endometrial resection in preventing the recurrence of endometrial polyps in post-menopausal patients and analyse the complications and necessity of additional surgery in patients, in addition to their degree of satisfaction. Methods: A prospective longitudinal study of post-menopausal patients diagnosed with endometrial polyps was conducted including polypectomy and hysteroscopic endometrial resection following the therapeutic purposes (endometrial polyp removal) and prevention of recurrence of endometrial polyps. We evaluated the general condition and characteristics of the patients, including age, BMI, smoking habits, medical, surgical, and obstetrics history and menstrual status. The results were analysed at several time points, 6, 18, 42 and 60 months by hysteroscopy, including the presence of vaginal bleeding and/or possible intracavitary pathology. Results: A total of 89.5% (n = 355) of our patients had profile factors associated with the increased incidence of endometrial polyps and hyperestrogenism (diabetes mellitus, hypertension and overweight); 89.5% (n = 355) of patients were overweight; 34% had grade I obesity. The surgical procedure was safe, with a 90% (n = 357) success rate without complications, which was higher than the 95-99.5% at the beginning and end time points of the study. Patient acceptance and satisfaction was 90 and 84%, respectively. Conclusions: Endometrial resection proved effective in preventing the recurrence of endometrial polyps. It is a safe and effective method. Post-menopausal bleeding reduces the presence of endometrial polyps. Patients reported satisfaction and acceptance of the procedure.

Journal of Minimally Invasive Gynecology, 2009

Caspian journal of internal Medicine, 2022

Background: Recurrence of endometrial polyp following the hysteroscopic polypectomy is a significant concern for both the patients and physicians. This study aimed to evaluate the efficacy of combining hysteroscopic polypectomy with endometrial resection in reducing the rate of recurrence in women over 40 years old. Methods: In a single-blinded clinical trial, 94 women with endometrial polyps who were unwilling to future pregnancy were identified and randomly allocated to the intervention (hysteroscopic‎ polypectomy + endometrial resection) ‎and control group (hysteroscopic‎ polypectomy alone) group (n=47/each). Randomization was done using a simple randomization technique‎. The primary outcome measure was the polyp recurrence. The secondary outcome measure was the number of adverse events. Results: In total, polyp recurrence occurred in two (4.3%) patients of the intervention group and nine patients (19.1%) of the control group (P=0.019). All the recurrences occurred in the premenopausal patients (P=0.012). No adverse event was observed in any patients of both groups. Conclusion: Adding endometrial resection to hysteroscopic polypectomy, especially in postmenopausal women, is a safe method that significantly reduces the risk of recurrence of the endometrial polyp.

The Cochrane database of systematic reviews, 2014

Endometrial polyps, which are benign growths of the endometrium, may be a factor in female subfertility. Possible mechanisms include physical interference with gamete transport, alteration of the endometrial milieu and unresponsiveness to the cyclical global endometrial changes. As such polyps remain mostly asymptomatic, their diagnosis is often incidental during routine investigations prior to embarking on assisted reproductive treatment. Transvaginal sonography, hysterosalpingography and saline infusion sonography are the diagnostic tools most commonly employed. However, hysteroscopy remains the gold standard for diagnosis, as well as for treatment. Due to the possible effect of endometrial polyps on fertility, their removal prior to any subfertility treatment is widely practiced. To determine the effectiveness and safety of removal of endometrial polyps in subfertile women. Electronic databases were searched, including the Cochrane Menstrual Disorders and Subfertility Group Speci...

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.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2010

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.

2019

Endometrial polyps (EPs) are a frequently encountered gynecologic disease with abnormal uterine bleeding and infertility being the two common presenting problems, and hysteroscopic polypectomy is an effective method to remove them. The postoperative polyp recurrence might result in reappearance of abnormal uterine bleeding or infertility, whereas factors influencing the postoperative recurrence potential have limited data. Endometrial polyp recurrence remains a concern with recurrence rates of 2.5% to 43.6%. As such, it is critical to identify the risk factors and the preventive measures for endometrial recurrence, especially in reproductive-age women desiring future conception, to aid in clinical counselling and decision making. The recurrence of EPs is related to estrogen stimulation and endometrial hyperplasia. The progesterone-containing drugs are currently the most commonly used method to prevent the recurrence of EPs. In this article, authors aim to discuss the high-risk factors of EPs recurrence and the preventive measures for EPs recurrence. The preventive measures will focus on the combined oral contraceptives (COCs) and the levonorgestrel-releasing intrauterine system (LNG-IUS).