Study Finds High Prevalence of Endometrial Polyps in Asymptomatic Hysterectomy Patients

Research revealed that 33.4% of 317 asymptomatic postmenopausal women undergoing hysterectomy for uterovaginal prolapse had endometrial polyps. These polyps were typically 13 mm in size on average, with 78% being solitary. Although the overall risk of malignancy was low, with only 1.89% presenting premalignant or malignant lesions, the study identified higher body mass index (BMI) and use of menopausal hormone therapy as significant risk factors.

Endometrial polyps are growths on the lining of the uterus that can sometimes lead to complications if left untreated. The prevalence of endometrial polyps in asymptomatic postmenopausal women is not well established. There is also a lack of clear clinical guidelines on how to manage these polyps and whether they should be considered a significant clinical concern in this population.

To fill this knowledge gap, Gabriela M. WEIGEL, Brown University/Women and Infants Hospital, Providence, RI, and colleagues determined the prevalence of endometrial polyps in asymptomatic postmenopausal women (those without bleeding) and assessed the risk factors linked to their occurrence.

This cross-sectional study examined the prevalence of endometrial polyps in asymptomatic postmenopausal women undergoing hysterectomy for uterovaginal prolapse. Women who had hysterectomies for other reasons, such as postmenopausal bleeding, were excluded from the study. The analysis was conducted on patient records from a single facility in Washington state, spanning from 2009 to 2018.

The primary outcome was the detection of endometrial polyps in pathology reports. Risk factors related to polyps presence were evaluated through univariate analysis and multivariate regression.

The study led to the following findings:

• Of the 317 eligible women identified, endometrial polyps were identified in 33.4% of women.
• The average polyp size and endometrial thickness were 13 +/- 10mm and 1.4 +/- 1.5mm. In most cases, 78% had solitary polyps.
• Premalignant and malignant lesions in 2 cases (1.89%); one had endometrial carcinoma, and one had endometrial intraepithelial neoplasia.
• Baseline clinical and demographic characteristics were similar between patients with and without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis.
• Multivariate logistic regression showed that the presence of polyps was independently associated with high body mass index (OR 1.06) and use of menopausal hormone therapy (OR 1.67).

The findings showed a high prevalence of endometrial polyps in symptomatic postmenopausal women undergoing hysterectomy for uterovaginal prolapse. Those with use of menopausal hormone therapy and high BMI are at a higher risk of developing endometrial polyps.

"Although the risk of malignancy appears to be low, further research is needed to accurately determine the lifetime risk. In the meantime, an expectant management approach may be appropriate for asymptomatic polyps that are discovered incidentally," the researchers conclude.

Reference:

WEIGEL, G. M., BAISON, G. N., MIHALOV, L., & MUPOMBWA, T. (2024). Prevalence of and risk factors for endometrial polyps among asymptomatic postmenopausal women with uterovaginal prolapse. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2024.08.001