ELDEEB M.W, HAZEM A., AHMED D., FOUDA E., ABOU SHOER M., ELSHERBENY A., SHAWKY O.

1. ELDEEB M.W, HAZEM A., AHMED
D., FOUDA E., ABOU SHOER M.,
ELSHERBENY A., SHAWKY O.

2. Endometrial polyps are localised
hyperplasic overgrowths of endometrial
glands and stroma which form projections
from the surface of the endometrium.

3. They can be single or multiple and range
from a few millimetres to several
centimetres.

4. Endometrial polyps are one of the most
common etiologies of abnormal genital
bleeding in both premenopausal and
postmenopausal women.
Lieng M et al ,( 2010 )

5. - They may also be asymptomatic.
- The great majority of endometrial polyps are benign,
but malignancy occurs in some women.
Lee et al,( 2010)
- In 46 studies (9266 pre &post menopausal patients ),
The prevalence of atypia and malignancy was 0.8%
and 3.1%, respectively
ELieng M, Istre O, Qvigstad E., et al (2010) & Mittal K, Da CostaD.(2008)
- Approximately 95 percent of endometrial polyps are
benign .
Baiocchi G et al,( 2009 )

6. Several molecular mechanisms have been
proposed to play a role in the development of
endometrial polyps. These include monoclonal
endometrial hyperplasia,
Jovanovic AS, Boynton KA, Mutter GL(1996)

7. over expression of endometrial aromatase,
Maia H Jr, Pimentel K, Silva TM (2006)& Pal L, Niklaus AL,KimM(2008)
and gene mutations
Dal Cin P, Vanni R, Marras S,( 1995)&Nogueira AA, Sant'Ana de Almeida
EC, Poli Neto OB,(2006)

8. Endometrial polyps express both estrogen
and progesterone receptors
Gul A, Ugur M, Iskender C, ( 2010 )
Progesterone may serve as anti proliferative
function … as well as androgens .

9. Endometrial polyps are rare among
adolescents.
Davis VJ, Dizon CD, Minuk CF. (2005 )
The prevalence appears to rise steadily with
increasing age, and to be higher in
premenopausal than postmenopausal
women (6 versus 12 percent in one study).
Salim S, Won H, Nesbitt-Hawes E, (2011)

10. - Most risk factors for endometrial polyps
involve increased levels or activity of
endogenous or exogenous estrogen.
- A number of studies report an increased
incidence of endometrial polyps in women on
hormone replacement therapy (HRT).
- Endometrial polyp formation appears to be
related to the type and dosage of the estrogen
and progestogen inHRT.
- A progestogen with high anti-estrogenic
activity may have an important role in
preventing the development of endometrial
polyps.9
Oguz S, et al (2005)

11. - Polyps develop in 2 to 36 percent of
postmenopausal women treated with tamoxifen.
Runowicz CD, et al (2011)
- Malignant transformation of an endometrial
polyp appears to occur more frequently in
women on tamoxifen (up to 11 percent) than in
other women.
Cohen I (2004)
- Use of the levonorgestrel-releasing intrauterine
device (IUD) may decrease the incidence of
endometrial polyps in women on Tamoxifen.

12. - Endometrial polyps appear to be associated with
obesity.
Onalan R, Onalan G, Tonguc E, et al (2009)
- Those with a BMI ≥30 had a significantly higher
rate of polyps than other women (52 versus 15
percent).
Onalan R, Onalan G, Tonguc E, et al(2009)
However, these data may not be generalizable to
other women.

13. CLINICAL PRESENTATION
 Endometrial polyps are typically identified in
association with abnormal uterine bleeding.
 Many polyps are asymptomatic and are
discovered as the result of an evaluation for
infertility .. Endometrial sampling, pelvic
imaging, or hysteroscopy.
 In some women, prolapse of the polyp occurs
and it can be visualized at the external cervical
os during pelvic examination.

14. Diagnostic Studies
Transvaginal ultrasound (TVUS)
Saline infusion sonogram (SIS)

15. Hysteroscopy

19. DIAGNOSIS
The diagnosis of an endometrial polyp is a
histologic diagnosis based upon the
evaluation of the specimen after it has
been removed.
Histological evaluation can also exclude
malignancy.

20. Malignant Endometrial Polyps

21. Effect on fertility and pregnancy
 Women undergoing evaluation for infertility may
have a finding of an endometrial polyp on ultrasound
or hysteroscopy; the reported prevalence in those
undergoing in vitro fertilization is 6 to 8 percent .
Karayalcin R, Ozcan S, Moraloglu O, et al(2010)
 A systematic review concluded that removing polyps
was beneficial in infertile women
Lieng M, et al (2010)
 This conclusion was based primarily on a single
randomized trial (n = 204) that showed a higher
pregnancy rate in women undergoing IUI who
underwent polyp removal compared with
hysteroscopy alone (63 versus 28 percent).
Pérez-Medina T, et al (2005)

22. - Endometrial polyps do not appear to be
associated with an increased risk of
spontaneous abortion or adverse obstetric
outcomes.
Souza CA, et al ( 2011 )

23. CHOOSING A MANAGEMENT APPROACH
Symptomatic endometrial polyps should be removed in all
women.
The goal of polypectomy is both relief of symptoms and
detection of malignancy.
Asymptomatic women
Polypectomy is preferred if :
 Polyp >1.5 cm in diameter
 Multiple polyps
 Polyp prolapsed through the cervix
 Infertility

24. POLYPECTOMY
Polypectomy under hysteroscopic guidance is the
treatment of choice for most endometrial polyps.

27. The TRUCLEARTM 5 mm 0-degree hysteroscopic
morcellator simultaneously resects and aspirates
endometrial polyps and small fibroids.

28. Hysteroscopy polyp snare. The loop is placed around the
base of the polyp and closed. A current is applied and the
endometrial polyp cut at the base. The loop is then used
to grip the polyp, which is subsequently removed under
vision, together with the hysteroscope.

29. Gynecare Alphascope hysteroscopy system
consisting of a 0-degree hysteroscope (bottom)
and a single-use sheath (top), containing in and
outflow tubing and an expandable operating
channel .