Uterine polypectomy in the management of abnormal uterine bleeding: A systematic review

In order to assess the efficacy of uterine polypectomy in the treatment of abnormal uterine bleeding (AUB), we conducted a systematic review of the published literature. Relevant papers were identified through electronic scanning of MEDLINE (1966-2004), EMBASE (1980-2004), and the Cochrane Library, and manual searching of bibliographies of known primary and review articles. Studies were selected if the efficacy of uterine polypectomy in treating women with AUB (menstrual dysfunction, postmenopausal bleeding with or without hormone replacement/tamoxifen therapy) was estimated. Study selection, quality assessment, and data abstraction were performed independently and in duplicate. The main outcomes measured were relief of AUB symptoms measured in general terms (improvement from baseline, normalization of bleeding patterns) and patient satisfaction. Secondary outcomes included technical feasibility and complications. Ten uncontrolled observational studies with 617 women were identified. No randomized trials were found. The methodologic quality of included studies was poor. Hysteroscopic resection under general anesthesia was used to remove intrauterine polyps in all studies, although outpatient approaches with local anesthetic also were employed in three of these case series. No technical failures were reported, but three complications including one uterine perforation were described. All studies reported an improvement in symptoms of AUB after polypectomy (range 75%-100%) at follow-up intervals of between 2 and 52 months. A single study compared outpatient polyp removal under local anesthesia with inpatient, general anesthetic treatment and detected no significant difference in treatment outcomes (p = 0.7). It was only possible to stratify treatment outcome according to type of AUB in one small study, which detected no significant difference between polypectomy for menstrual dysfunction or postmenopausal bleeding (p = 0.2). In conclusion, there is a lack of high-quality evidence to reliably inform clinical practice regarding the efficacy of intrauterine polypectomy in women with AUB. The limited available evidence suggests that hysteroscopic polypectomy is a technically successful procedure that improves AUB symptoms. Further research in the form of a multicenter, randomized, controlled trial, stratified by technique, setting, and pattern of AUB, is required to assess the short- and long-term effects of this commonly practiced intervention.