Treatment of endometrial polyps: a systematic review.
BACKGROUND
Transcervical resection of endometrial polyps is usually performed in order to exclude atypic and/or malignant endometrial changes, to relieve abnormal uterine bleeding or to improve infertility.


OBJECTIVE
To systematically explore the rationale of transcervical polyp resection.


METHODS
Electronic searches of MEDLINE, EMBASE and The Cochrane Library.


METHODS
Studies reporting the prevalence of premalignant and/or malignant tissue changes within endometrial polyps, as well as outcomes of endometrial polyp removal in terms of symptom relief and improved fertility were included.


RESULTS
46 studies met the criteria for inclusion (malignancy: 20 studies including 9,266 women, symptom relief: 15 studies including 1,034 women, infertility: 11 studies including 935 women). Most studies were uncontrolled retrospective case series. Only two randomized controlled trials were identified. The prevalence of premalignant and malignant tissue changes within endometrial polyps varied in the included studies, 0.2-23.8% and 0-12.9%, respectively. Postmenopausal symptomatic women appeared to have the highest risk of premalignant and malignant tissue changes. The effect of polypectomy on periodic blood loss appeared to be questionable, but all studies measuring the effect of polypectomy by general terms such as improved/not improved reported a favorable outcome (75-100% success rate). Polypectomy appears to have a favorable outcome in infertile women.


CONCLUSIONS
The evidence which substantiates the removal of endometrial polyps is limited, and future research evaluating the outcome of this common procedure is required. Based on the available evidence, however, we provide recommendations for treatment of women with endometrial polyps.
Department of Gynecology, Oslo University Hospital, Ullevål, Oslo, Norway. m.lieng@online.no
Marit
M
Lieng
Olav
O
Istre
Erik
E
Qvigstad
D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery; D011127:Polyps / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017698:Postmenopause; D011230:Precancerous Conditions; D011247:Pregnancy; D018873:Pregnancy Rate; D014591:Uterine Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*