Endometrial Polyps: Which Patients Should Be Selected for Hysteroscopic Surgery?
—A Study Using Data from the Swedish National Quality Registry of Gynecological Surgery

Stefan Zacharias¹, Mats Löfgren^2*

¹Department of Obstetrics and Gynecology, Hudiksvall County Hospital, Hudiksvall, Sweden.
²Department of Clinical Sciences, Obstetrics and Gynecology, Umea University, Umea, Sweden.

DOI: 10.4236/ojog.2015.511084                

Abstract

Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were <52 years old (p < 0.001). Among those women with dysplasia, 12/41 (29%) were <52 years old (p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The <52-year-old cancer patient had treatment-resistant bleeding. Increasing weight was a risk factor associated with tissue alterations in endometrial polyps (p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.

Keywords

Endometrial Polyp, Menopause, Malignancy, Gynecological Surgery, Hysteroscopy

Conflicts of Interest

The authors declare no conflicts of interest.

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