A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding

Natalie A M Cooper,Jane Daniels,Lee Middleton,T Justin Clark,Elaine Denny,Lynda Stobert,Paul Smith

doi:10.1007/s10397-016-0946-4

Abstract

Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women’s preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy. Three hundred ninety-nine women with abnormal uterine bleeding who were found to have uterine polyps at diagnostic hysteroscopy were recruited. Office polypectomies were performed in office hysteroscopy clinics, and inpatient procedures were undertaken in operating theatres. Three hundred twenty-four of 399 (81 %) expressed a preference for office treatment. There was no difference found between office treatment and inpatient treatment in terms of alleviating abnormal uterine bleeding as assessed by patients and in improving disease-specific quality of life. Acceptability was lower and patient pain scores were significantly higher in the office group. When offered a choice of treatment setting for uterine polypectomy, patients have a preference for office over inpatient treatment. Ambulatory gynaecology services should be available within healthcare systems to meet patient demand.

Highlights

Abnormal uterine bleeding affects women of all ages and is the commonest reason for referral to secondary care [1, 2]
Uterine polyps are commonly found in association with abnormal uterine bleeding in both pre- and postmenopausal women [3,4,5,6,7] when investigated with ultrasound or office hysteroscopy
In clinics which provided a ‘see and treat’ service, consent was obtained and the patient was registered on the on-line recruitment system prior to the diagnostic hysteroscopy, so that if a uterine polyp was diagnosed and the woman’s preference was for office polypectomy, treatment could be performed straight away without an interruption to register the patient into the study

Summary

Introduction

Abnormal uterine bleeding affects women of all ages and is the commonest reason for referral to secondary care [1, 2]. Uterine polyps are commonly found in association with abnormal uterine bleeding in both pre- and postmenopausal women [3,4,5,6,7] when investigated with ultrasound or office hysteroscopy. Whilst recruiting to a randomised controlled non-inferiority study which compared office to inpatient polypectomy, we collected data from women who consented to be followed-up, but had a preference for how they were treated and so could not be randomised.

Methods

Results

Conclusion