Marit Lieng

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. Search strategy. Electronic searches of MEDLINE, EMBASE and The Cochrane Library. Selection criteria. 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. Main 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.

Prevalence, 1-Year Regression Rate, and Clinical Significance of Asymptomatic Endometrial Polyps: Cross-sectional Study

STUDY OBJECTIVE To estimate the prevalence, 1-year regression rate, and clinical significance of endometrial polyps in women aged 45 to 50 years. DESIGN Cross-sectional study (Canadian Task Force II-2). SETTING University teaching hospital. PATIENTS Two hundred fifty-seven of 1000 randomly selected women aged 45 to 50 years. INTERVENTIONS Transvaginal ultrasonography and saline infusion sonography were performed in all study participants and were repeated in women with endometrial polyps after 12 months. Polyps present at follow-up were removed by hysteroscopic polyp resection. MEASUREMENTS AND MAIN RESULTS Endometrial polyps were diagnosed in 31 women (12.1%). At 1 year, the polyp regression rate was 27%. Myomas occurred more often in women with endometrial polyps, and women with polyps experienced significantly heavier periodic bleeding compared with women without polyps. CONCLUSION Our study findings suggest that endometrial polyps are common in women aged 45 to 50 years and that women with such polyps experience heavier periodic bleeding. Although some polyps seem to regress spontaneously during 1-year follow-up, most seem to persist.

Long-term outcomes following laparoscopic supracervical hysterectomy.

Objective  Evaluation of long‐term outcomes following laparoscopic supracervical hysterectomy (LSH).

A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial

Objective  To compare the impact of 1000 μg of self‐administered vaginal misoprostol versus self‐administered vaginal placebo on preoperative cervical ripening after 2 weeks of pretreatment with estradiol vaginal tablets in postmenopausal women prior to day‐care operative hysteroscopy.

Clinical Effectiveness of Transcervical Polyp Resection in Women with Endometrial Polyps: Randomized Controlled Trial

STUDY OBJECTIVE To estimate the clinical effectiveness of transcervical resection of endometrial polyps. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING University teaching hospital. PATIENTS One hundred fifty premenopausal women with endometrial polyps. INTERVENTIONS Either transcervical resection of the polyp or observation for 6 months. MEASUREMENTS AND MAIN RESULTS There was no difference in periodic blood loss measured using the Pictorial Blood Assessment Chart between the study groups at 6-month follow-up. A significant difference between the groups was observed in favor of the intervention group for 2 secondary outcome measures: mean difference of periodic blood loss measured using a visual analog scale (score, 0.7; 95% confidence interval, 0.11-1.30; p = .02) and occurrence of gynecologic symptoms at follow-up (7 of 75 patients [9.3%] vs 28 of 75 [37.3%]; p <.001). Data were analyzed according to the principle of intention to treat. CONCLUSION Transcervical resection of endometrial polyps seems to have minimal effect on periodic blood loss; however, the procedure seems to relieve symptoms such as intermenstrual bleeding in most premenopausal women.

Flow differences between endometrial polyps and cancer: a prospective study using intravenous contrast‐enhanced transvaginal color flow Doppler and three‐dimensional power Doppler ultrasound

To evaluate whether assessment of blood flow by transvaginal color Doppler and three‐dimensional power Doppler imaging, enhanced by intravenous contrast, may be useful in the differentiation between benign endometrial polyps and endometrial cancer.

Ectopic pregnancy after levonorgestrel emergency contraception

BACKGROUND Although the possibility of ectopic pregnancy after intake of levonorgestrel (LNG) as an emergency contraceptive (EE) pill is well-known, the causality has not been well established. CASE A 27-year-old nulliparous woman with regular menstrual periods took 1.5-mg LNG EE midcyclic 5 h after an unprotected intercourse. She had prolonged vaginal bleeding at the expected time. She consulted the general practitioner because of continuous vaginal bleeding for 4 weeks and lower abdominal pain. The pregnancy test was positive, and her symptoms and clinical findings suggested an ectopic pregnancy. At emergency surgery, she was found to have a left tubal pregnancy. CONCLUSION The possible role of 1.5-mg LNG EE in causing ectopic pregnancy is discussed. A high serum LNG concentration decreases ciliary activity and tube motility, but further epidemiological studies are necessary to establish the risk of ectopic pregnancy following intake of LNG EE.

Uterine leiomyosarcoma - incidence, treatment, and the impact of morcellation. A nationwide cohort study.

The risk of morcellation of occult uterine leiomyosarcomas (LMS) during laparoscopic procedures has been under scrutiny over recent years. The objective of this study was to assess the operative treatment performed in women with uterine LMS in Norway in 2000–2012, including the number of morcellated LMS.

Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies.

Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.

Surgical treatment of benign gynecological disorders

BACKGROUND All of Norways inhabitants are entitled to health services of a good and equal quality. The aim of this study was to evaluate whether women with benign gynaecological disorder are treated according to this principle. Guidelines recommend that the laparoscopic technique should be used to operate ectopic pregnancies and ovarian cysts. Vaginal or laparoscopic technique should be used for hysterectomies. MATERIAL AND METHODS Recording of surgical modality used in gynaecological departments in Norway to treat ectopic pregnancies, ovarian cysts and hysterectomies on the indication bleeding disorders and/or fibroids. Data were retrieved from the National Patient Register for the years 2003 - 06. RESULTS The proportion of operations performed with laparotomy was gradually reduced for the conditions assessed during the period of observation. 24 % of women with ectopic pregnancies were operated with laparotomy in 2003 and 14 % in 2006; 50 % of women with ovarian cysts were operated with the technique in 2003 and 41 % in 2006. For hysterectomies due to bleeding disorders and/or fibroids, the frequency of laparotomies decreased from 75 % in 2003 to 62 % in 2006. Adherence to guidelines is best in departments that perform many operations. INTERPRETATION Different surgical approaches are used to treat the same benign gynecological disorders in Norway. The reason for this difference has not been evaluated, but it may be explained by tradition, lack of competence and inadequate training of gynecologists.