Objective
The aim of this study was to evaluate the incidence of endometrial carcinoma, proven after hysterectomy, in patients diagnosed with atypical endometrial hyperplasia confined to a polyp. A secondary aim was to establish factors associated with (pre‐)malignant alterations in a polyp.
Design
A retrospective cohort study.
Setting
Maastricht University Medical Centre (MUMC+) and Máxima Medical Centre in Eindhoven/Veldhoven (Máxima MC).
Population
Women who underwent a hysteroscopic polyp resection between 2008 and 2016.
Methods
Patient characteristics and histopathology results of the polyp and, in the case of a hysterectomy, uterus were collected from patients’ charts.
Results
A total of 1445 complete hysteroscopic polyp resections were included. Of those, 1390 polyps showed benign histopathology results, 39 polyps contained atypical hyperplasia and 16 polyps contained endometrial carcinoma. A hysterectomy was performed in 35 women who were diagnosed with atypical hyperplasia confined to a polyp after hysteroscopic polyp resection. Histopathological assessment showed no additional (pre‐)malignant changes of the endometrium in 12 women (30.8%), atypical hyperplasia in 11 women (28.2%) and endometrial carcinoma in 12 women (30.8%). None of the prognostic factors under consideration were significantly associated with (pre‐)malignant changes in a polyp.
Conclusion
The incidence of endometrial carcinoma in the surrounding endometrium after complete resection of a polyp with atypical hyperplasia is 30.8% in this study. This supports the current advice to perform a hysterectomy and bilateral salpingo‐oophorectomy. No prognostic factor for (pre‐)malignant changes in a polyp was established.
Tweetable abstract
The incidence of endometrial carcinoma after complete resection of a polyp with atypical hyperplasia is high.
Objectives: Up to 60% of women remove their levonorgestrel-releasing Intrauterine System (LNG-IUS) prematurely, mostly because of irregular bleeding disturbances up to six months after insertion. Assuming ongoing bleeding is due to atrophic bleeding of the endometrium, treatment with ooestrogen could be effective. No study in literature supports ooestrogen therapy for irregular bleeding in LNG-IUS users.
Study design:A prospective cohort study was conducted in two hospitals to evaluate the effect of oral ooestradiol (started six months after LNG-IUS insertion) on irregular bleeding days. The participating women received 2mg ooestradiol daily for six weeks. We observed the discontinuation rate, the occurrence of adverse events and side effects due to ooestradiol. Women completed questionnaires at baseline and three months after start of the treatment.Results: Nineteen women were included. A median of 21 irregular bleeding days per month at baseline decreased to a median of five irregular bleeding days per month (p=0.003) after the use of ooestradiol for six weeks. Three out of nineteen women had their LNG-IUS removed at three months follow-up because of persistent irregular bleeding. No adverse events were reported, however, 68% of the participants reported side effects.
Conclusion:In this study we observed a decrease in the number of irregular bleeding days in LNG-IUS users with ongoing irregular bleeding (>6 months after insertion), after administering oral ooestradiol for six weeks. We propose to conduct a larger prospective trial to evaluate ooestradiol as treatment option for irregular bleeding.
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