OC21.03: Natural history of asymptomatic endometrial polyps in postmenopausal women: a 10‐year follow‐up study

Abstract

Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of pre- and malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ⩽ 4 mm) in asymptomatic postmenopausal women. 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth > 50% at follow-up. Demographic, sonographic and surgical data were recorded. Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of follow-up, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.