Open AccessTreatment of endometrial polyps: a systematic review
Author(s) -
LIENG MARIT,
ISTRE OLAV,
QVIGSTAD ERIK
Publication year - 2010
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.3109/00016349.2010.493196
Subject(s) - medicine , endometrial polyp , polypectomy , cochrane library , malignancy , infertility , gynecology , endometrial cancer , hysteroscopy , randomized controlled trial , obstetrics , cancer , surgery , colonoscopy , colorectal cancer , pregnancy , biology , genetics
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.