WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.
"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.
The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.
Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.
Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.
Dr. Hartman said he had no relevant financial disclosures.