Asymptomatic endometrial polyps in postmenopausal women: are they an indication for surgical removal?

Abstract

Purpose: To compare demographic, sonographic, and outcome data of postmenopausal patients with asymptomatic endometrial polyp, surgically treated or not treated. Methods: Ninety postmenopausal women with sonographic/sonohysterographic diagnosis of asymptomatic endometrial polyp were prospectively enrolled in this study. All patients underwent transvaginal sonography with color Doppler evaluation (Voluson 5300, KRETZ), and sonohysterography in selected cases. Patients were counseled on the risk of malignancy (estimated risk < 1/200). Sonographic follow up at 3, 6 and 12 months was proposed as an option to standard hysteroscopic polipectomy. Surgery was considered in case of bleeding, polyp enlargement, or Doppler PI < 0.6. Demographic and sonographic data of both groups were recorded. Surgical complications in group B patients were considered as abnormal outcome. Results: Sonographic follow up was chosen by 42 women (group A) and surgical removal by 47 patients (group B). Forty‐three patients underwent operative hysteroscopy, and four patients hysterectomy (group B). One major (uterine perforation not requiring surgery) and three minor complications (two cervical lacerations requiring hemostatic suturing, one false entry) (9%). Demographic (age, years of menopause, blood hypertension/diabetes, BMI, nulligravidity, hormonal replacement therapy assumption, tamoxifen assumption) and sonographic data) Endometrial thickness mean (interquartile range) = 8 (5–10) vs. 11 mm (7–13); volume (cc): 3 (1–4) vs. 4 (1–5); PI: 0.48 (0.44–0.51) vs. 0.49 (0.45–0.53) were not significantly different between group A and B. Pathologic findings were glandulocystic and hyperplastic polyp in 45 and in two patients, respectively. All group A patients remained asymptomatic in the follow up period (mean 10 months, interquartile range 5–16). Conclusions: Demographic and sonographic data were not significantly different in the two groups. No untreated patient became symptomatic during follow up period. Benign lesions only were found in treated patients, at the cost of one uterine perforation. A large multicentre study is needed to understand the exact prevalence of endometrial cancer in asymptomatic endometrial polyp, and verify the safety of conservative management.