Introduction/Background*The significance of endometrial polyps in women presenting with post menopausal bleeding (PMB) is uncertain, with variable risk of malignancy between 3.5% and 6%. Outpatient hysteroscopy is now the standard of care for endometrial assessment with hysteroscopic polypectomy is increasingly performed in this setting. We aimed to establish the relevance and malignancy risk in women with solitary or multiple polyps presenting with PMB.
Methodology A retrospective review of prospectively recorded data between October 2017 and December 2019; during which 449 patients underwent outpatient hysteroscopy and polypectomy for bleeding. Records were interrogated for patient, procedural and histological factors.
Result(s)*The mean age of patients undergoing polypectomy was 63 [IQR 55-70] years. Of these only 69/449 (15%) did not have polyps detected on ultrasound prior to hysteroscopy. Vaginoscopic hysteroscopy was attempted in 398 cases was successful in 359 (90%) of cases. Quality of assessment was determined by stated visualization of both ostia, this was achieved in 400 (89%) cases. Only 98 cases (21%) were described as difficult of which the main causes were cervical stenosis, cervical tortuosity or uterine lie.
For patients undergoing a single polypectomy (n=286). 276 cases were benign, 9 had hyperplasia without atypia, 7 had hyperplasia with atypia and 17 had cancers with one sample insufficient.
For patients undergoing multiple polypectomy (n=162). 137 cases were benign, 10 had hyperplasia without atypia, 7 had hyperplasia with atypia and cancer was diagnosed in 21.
The rate of cancer in multiple polyps and single polyps was 13% and 6% respectively, with multiple polyps conveying a 2.04 x increased risk of malignancy.
Conclusion*Outpatient polypectomy is a safe and well tolerated procedure with low complication rates. Multiple polyps can be resected in outpatient see-and-treat setting and should be encouraged due to the increased rates of cancer seen in those with multiple polyps.