Endometrial Polyps in Reproductive Age: Is There Malignancy Potential? Should We Always Treat?

Endometrial Polyps in Reproductive Age: Is There Malignancy Potential? Should We Always Treat?

Konstantinos Dafopoulos (Assisted Reproduction Unit, Department of Obstetrics and Gynecology, University of Thessaly, Larisa, Greece) and Vasileios Tsilionis (Department of Obstetrics and Gynecology, University of Thessaly, Larisa, Greece)
DOI: 10.4018/978-1-7998-4213-2.ch007

Abstract

Endometrial polyps are endometrial masses that consist of glands, stroma, and vessels. They can be single or multiple, sessile or pedunculated, and range in size from some millimeters up to several centimeters. Despite the fact they rarely cause symptoms, they are usually found on a routine examination. Therefore, they are a common problem on daily clinical practice. The question of potential malignancy risk as well as the necessity of further treatment are often posed. The present chapter summarizes current evidence regarding risk of malignant transformation as well as indications and methods of appropriate treatment.
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Introduction

Endometrial polyps are endometrial masses that consist of glands, stroma, and vessels (Kim et al, 2004). They can be single or multiple, sessile or pedunculated and range in size from some millimeters up to several centimeters. Since they rarely cause symptoms, they are usually found on a routine examination. While transvaginal ulttasonography is considered as a reliable means for their diagnosis, the combination with liquid infusion in the endometrium (with or without 3D imaging) improves the diagnostic accuracy. However, dilation & curettage (D&C) or endometrial biopsy should not be used as a diagnostic tool.

In premenopausal women, the most common symptom seems to be the abnormal uterine bleeding (AUB). This may have the characteristics of metrorrhagia, spotting, but also menorrhagia. Moreover, endometrial polyps are related to infertility, as they have been found to be more common in infertile than in fertile women. In addition, there is evidence of improvement in fertility following the removal of polyps (Hinckley & Milki, 2004; Perez-Medina et al, 2005). In postmenopausal women, the most common symptom is postmenopausal uterine bleeding.

Frequency of Polyps at Women of Reproductive Age

One study investigated the frequency of endometrial polyps in the general Danish population aged 20-74 years (Dreisler et al, 2009). From this population, 429 were premenopausal women with an incidence of endometrial polyps of 5.8%, while in postmenopausal women the incidence was 11.8%. Other studies have also shown that the incidence of polyps increases with age before menopause, and in the 20-29 age group only 0.9% were diagnosed with polyps (Dreisler et al, 2009). In addition, in premenopausal women without AUB, the prevalence of endometrial polyps was 7.6%, while in those with AUB was 3.7% (Dreisler et al, 2009). Another study in the general population of women over 30 years old, without AUB, showed that the frequency of polyps was 10% (Clevenger-Hoeft et al, 1999). In other studies investigating premenopausal women with AUB, the frequency of polyps has been found to range between 10-40% (Nagele et al, 1996; Clevenger-Hoeft et al, 1999; Anastasiadis et al, 2000). The symptoms do not seem to be related to the size, the number, and the position of endometrial polyps (Hassa et al, 2006).

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