To treat or not to treat? An evidence-based practice guide for the management of endometrial polyps

Abstract

Endometrial polyps are a common finding, with a prevalence of about 40%, and are usually diagnosed incidentally as most are asymptomatic. Symptomatic polyps usually present with abnormal uterine bleeding and/or sub-fertility. About 25% of polyps resolve spontaneously if managed conservatively. The usual management of endometrial polyps, symptomatic or asymptomatic, is polypectomy, performed primarily to exclude malignancy within the polyp despite the overall risk of malignancy being low (about 3%). The main risk factors for malignancy are menopause and abnormal uterine bleeding, with hypertension, obesity, diabetes mellitus, and tamoxifen use thought to play a lesser role. Transvaginal ultrasonography is the primary diagnostic tool for endometrial polyps although visualization by hysteroscopy is the gold standard for diagnosis. There is no proven preventative or medical treatment, with complete polyp removal under hysteroscopic guidance the recommended surgical treatment. Some women may decline surgical endometrial polyp management due to the small inherent risks. Conservative management is an option for asymptomatic premenopausal and postmenopausal women, whilst polypectomy is recommended for all women with abnormal uterine bleeding. Management should be individualized and made in consultation with the patient.

摘要

子宫内膜息肉是一个常见的疾病, 患病率约为40%, 因为大多数无症状, 所以通常是偶然诊断的。有症状的息肉通常表现为子宫异常出血和/或不孕。如果处理得当, 大约25%的息肉会自然消退。子宫内膜息肉的常见治疗是息肉切除术, 不管是有症状或无症状的, 主要是为了排除息肉内的恶性肿瘤, 尽管恶性肿瘤的总体风险较低（约3%）。恶性肿瘤的主要危险因素是更年期和子宫异常出血, 高血压、肥胖、糖尿病和他莫昔芬应用被认为起次要作用。经阴道超声是子宫内膜息肉的主要诊断工具, 尽管宫腔镜下的可视化是诊断的金标准。目前尚无有效的预防性或医学治疗方法, 在宫腔镜指导下完全切除息肉是推荐的手术治疗方法。一些妇女可能会因为固有的小风险而拒绝子宫内膜息肉的手术治疗, 对于无症状的绝经前和绝经后妇女, 保守治疗是一种选择, 而对于所有子宫异常出血的妇女, 则建议进行息肉切除术。子宫内膜息肉管理应个体化并与患者协商。

Keywords:

• Endometrial polyp
• malignancy
• adenocarcinoma
• presentation
• diagnosis
• management

Potential conflict of interest

No potential conflict of interest was reported by the author(s).

Source of funding

Nil.