Polypectomy in premenopausal women with abnormal uterine bleeding: effectiveness of hysteroscopic removal.
OBJECTIVE
To estimate the effectiveness of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding and to identify prognostic factors for persistence or recurrence of symptoms after polypectomy.


METHODS
Retrospective study (Canadian Task Force classification II-3).


METHODS
University teaching hospital.


METHODS
Premenopausal women with abnormal uterine bleeding.


METHODS
Hysteroscopic polypectomy, regardless of whether combined with endometrial ablation or insertion of a levonorgestrel-releasing intrauterine device.


RESULTS
Seventy-eight consecutive patients met the inclusion criteria and were followed over time. Data were retrieved from medical records or from additional questionnaires sent to the patients. Failure of treatment was defined as persistence or recurrence of abnormal uterine bleeding after polypectomy, requiring further treatment. The mean age was 44.2 years (SD 5.2, 95% CI 33.9-54.4 years). Intervention-free survival after polypectomy, as calculated by Kaplan-Meier survival analysis, was 41.1% (SE 8.3%, 95% CI 24.8%-57.4%) after 4 years for patients who underwent only hysteroscopic polypectomy and 54.7% (SE 13.6%, 95% CI 28.0%-81.4%) for patients who underwent a polypectomy combined with endometrial ablation or insertion of a levonorgestrel-releasing intrauterine device (p = .08). Cox regression analyses revealed no statistically significant predictors for persistence or recurrence of symptoms after polypectomy.


CONCLUSIONS
Nearly 60% of patients required further treatment for persistence or recurrence of abnormal uterine bleeding 4 years after hysteroscopic polypectomy. Although not significant, outcome of treatment tended to improve by combining polypectomy with either an endometrial ablation or insertion of a levonorgestrel-releasing intrauterine device.
Henriquez
Dacia D C A
DD
Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
van Dongen
Heleen
H
Wolterbeek
Ron
R
Jansen
Frank Willem
FW
D000328:Adult; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007436:Intrauterine Devices, Medicated; D053208:Kaplan-Meier Estimate; D016912:Levonorgestrel / Q000627:therapeutic use; D008796:Metrorrhagia / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D011127:Polyps / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D017211:Treatment Failure; D014591:Uterine Diseases / Q000150:complications / Q000601:surgery*
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel