Department of Obstetrics and Gynaecology, Mater Clinic, Sydney, Australia.
Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, Australia.
Climacteric. 2020 Aug;23(4):336-342. doi: 10.1080/13697137.2020.1742107. Epub 2020 Jun 4.
Endometrial polyps are a common finding, with a prevalence of about 40%, and are usually diagnosed incidentally as most are asymptomatic. Symptomatic polyps usually present with abnormal uterine bleeding and/or sub-fertility. About 25% of polyps resolve spontaneously if managed conservatively. The usual management of endometrial polyps, symptomatic or asymptomatic, is polypectomy, performed primarily to exclude malignancy within the polyp despite the overall risk of malignancy being low (about 3%). The main risk factors for malignancy are menopause and abnormal uterine bleeding, with hypertension, obesity, diabetes mellitus, and tamoxifen use thought to play a lesser role. Transvaginal ultrasonography is the primary diagnostic tool for endometrial polyps although visualization by hysteroscopy is the gold standard for diagnosis. There is no proven preventative or medical treatment, with complete polyp removal under hysteroscopic guidance the recommended surgical treatment. Some women may decline surgical endometrial polyp management due to the small inherent risks. Conservative management is an option for asymptomatic premenopausal and postmenopausal women, whilst polypectomy is recommended for all women with abnormal uterine bleeding. Management should be individualized and made in consultation with the patient.
子宫内膜息肉是一种常见的疾病，其患病率约为 40%，通常是无症状的，多数是偶然诊断出来的。有症状的息肉通常表现为异常子宫出血和/或不孕。如果采用保守治疗，大约 25%的息肉会自行消退。子宫内膜息肉的常规治疗方法（有症状或无症状）是息肉切除术，主要目的是排除息肉内的恶性肿瘤，尽管总体恶性肿瘤风险较低（约 3%）。恶性肿瘤的主要危险因素是绝经和异常子宫出血，高血压、肥胖、糖尿病和他莫昔芬的使用被认为具有较小的作用。经阴道超声是子宫内膜息肉的主要诊断工具，尽管宫腔镜检查是诊断的金标准。目前尚无有效的预防或药物治疗方法，建议在宫腔镜引导下进行完全息肉切除的手术治疗。由于存在较小的固有风险，一些女性可能会拒绝手术治疗子宫内膜息肉。对于无症状的绝经前和绝经后妇女，保守治疗是一种选择，而对于所有异常子宫出血的妇女，建议进行息肉切除术。治疗方法应个体化，并与患者协商决定。
