Major Finding: Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.
Data Source: A prospective study of 1,500 consecutive asymptomatic women.
Disclosures: Dr. Hartman said that he had no relevant financial disclosures.
WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.
“We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp,” Dr. Michael Hartman of Memorial University of Newfoundland, St. John's, Canada, said in a poster presentation at the meeting. “The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps.”
Dr. Hartman explained in an interview: “Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries.”
In a study of women aged 45–95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.
Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal-appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).
These findings do not support routine ultrasound screening of older asymptomatic women. “In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps,” Dr. Hartman stated.