ENDOMETRIAL POLYPS Endometrial polyps are localized hyperplastic overgrowths of endometrial glands and stroma that form a sessile

e or pedunculated projection from the surface of the endometrium. Single or multiple polyps can occur that range from a few millimeters to several centimeters in size. They rarely contain foci of neoplastic growth. In one large series of 50 consecutive women with endometrial polyps removed !y operative hysteroscopy" histology was !enign in #0 percent" and showed hyperplasia without atypia in $% percent" hyperplasia with atypia in & percent" and cancer in 0.' percent ($%). The mean age of the women was 5% years and just over one*half had a!normal uterine !leeding. Epidemiology Endometrial polyps are rare among women younger than $0 years of age. The incidence rises steadily with increasing age" pea+s in the fifth decade of life" and gradually declines after menopause. ,mong women undergoing endometrial !iopsy or hysterectomy" the prevalence of endometrial polyps is -0 to $. percent ($#). Clinical feature Endometrial polyps are responsi!le for appro/imately one* fourth of cases of a!normal genital !leeding in !oth premenopausal and postmenopausal women ($#). 0See 1Evaluation and management of a!normal uterine !leeding in premenopausal women1 and see 1Evaluation and management of uterine !leeding in postmenopausal women12. 3etrorrhagia 0ie" irregular !leeding2 is the most fre4uent symptom in women with endometrial polyps" occurring in a!out one*half of symptomatic cases. 5ess fre4uent symptoms include menorrhagia" postmenopausal !leeding" prolapse through the cervical os" and !rea+through !leeding during hormonal therapy. Diagno i Endometrial polyps are diagnosed !y microscopic e/amination of a specimen o!tained after curettage" endometrial !iopsy" or hysterectomy. E/cision permits !oth diagnosis and cure of these lesions. 6either ultrasonography nor hysteroscopy can relia!ly distinguish !etween !enign and malignant polyps ($'"$ ). Natural !i tory , prospective study on the course of endometrial polyps performed two saline infusion sonograms $.5 years apart on %. initially asymptomatic women 0mean age .. years2 (&-). Seven women had polyps on the first e/amination. 7our of these women had spontaneous regression of their polyps at the second scan" while seven women developed new polyps over the $.5 year interval. 8olyps larger than - cm were least li+ely to regress. 9ormone use did not appear to affect the natural history of the polyps" !ut the study sample was small. Treatment Thorough curettage cures the majority of cases of endometrial polyps. :urettage followed !y !lind e/traction with ;andall polyp forceps improves the detection rate over curettage alone (&$). 9ysteroscopic*guided curettage is recommended since small polyps and other structural a!normalities can !e missed !y !lind curettage (&&"&.). 7or women desiring pregnancy" short*term downregulation with a <n;9*agonist may !e useful. 9owever" clinical e/perience with this approach is restricted to a few case reports and symptoms reappear after discontinuation of agonist therapy. In a randomized trial with inclusion criteria $. months infertility" candidate for intrauterine insemination" and histologically confirmed sonographic diagnosis of endometrial polyp" hysteroscopic polypectomy !efore intrauterine insemination was associated with a significantly higher pregnancy rate 0%& versus $' percent in

controls2 (&5). =ased on this trial" and other data from o!servational studies" we remove endometrial polyps in infertile women" even in the a!sence of a!normal !leeding. Summary and recommendation ,!normal uterine !leeding" especially irregular !leeding" is the most fre4uent symptom associated with endometrial polyps. 9ysteroscopic*guided curettage is recommended to e/cise symptomatic polyps since small polyps and other structural a!normalities can !e missed !y !lind curettage. In infertile women with endometrial polyps" removal should !e considered as part of the treatment of infertility.

RE"ERENCES $%. Savelli" 5" >e Iaco" 8" Santini" >" et al. 9istopathologic features and ris+ factors for !enignity" hyperplasia" and cancer in endometrial polyps. ,m ? @!stet <ynecol $00&A -''B $#. $#. Can =ogaert" 5?. :linicopathologic findings in endometrial polyps. @!stet <ynecol - ''A #-B##-. $'. =en*,rie" ," <oldchmit" :" 5aviv" D" et al. The malignant potential of endometrial polyps. Eur ? @!stet <ynecol ;eprod =iol $00.A --5B$0%. $ . Shushan" ," ;evel" ," ;ojans+y" 6. 9ow often are endometrial polyps malignantE. <ynecol @!stet Invest $00.A 5'B$-$. &-. >eFaay" >?" Syrop" :9" 6ygaard" IE" et al. 6atural history of uterine polyps and leiomyomata. @!stet <ynecol $00$A -00B&. &$. <e!auer" <" 9afner ," Sie!zehnru!l E" 5ang 6. ;ole of hysteroscopy in detection and e/traction of endometrial polypsB results of a prospective study.,m ? @!stet <ynecol $00-A -'.B5 . &&. =roo+s" 8<" Serden" S8. 9ysteroscopic findings after unsuccessful dilatation and curettage for a!normal uterine !leeding. ,m ? @!stet <ynecol - ''A -5'B-&5.. &.. <impelson" ;?" ;appold" 9@. , comparative study !etween panoramic hysteroscopy with directed !iopsies and dilatation and curettageB a review of $#% cases. ,m ? @!stet <ynecol - ''A -5'B.' . &5. 8erez*3edina" T" =ajo*,renas" ?" Salazar" 7" et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine inseminationB a prospective" randomized study. 9um ;eprod $005A $0B-%&$.