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Objective To study the histopathology of endometrial polyps that had developed during 6–18 months of hormone‐replacement therapy (HRT), and to determine the status of oestrogen and progesterone receptors in these lesions. Design Retrospective study. Subjects Fifty‐five menopausal patients receiving HRT who had endometrial polyps. Interventions Polypectomy followed by endometrial resection. Results Endometrial polyps have foci of hyperplasia that do not respond to progestin in menopausal patients receiving HRT. This is associated with lack of progesterone receptors in both stroma and glands. On the other hand, oestrogen receptors are expressed in endometrial polyps. Conclusions Endometrial polyps in menopausal patients receiving HRT respond only to oestrogens but not to progestins. The unopposed oestrogenic action on polyps may favour the development of premalignant hyperplasia and carcinoma.

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Objective To investigate the cause of uterine bleeding in menopausal patients using hormone replacement therapy (HRT), and the efficacy of resectoscopic surgery for treatment of irregular vaginal bleeding caused by benign uterine pathology in such patients. Design Retrospective case series. Setting Endoscopy unit of a private urban hospital. Subjects 143 patients receiving HRT and with irregular vaginal bleeding, examined between January 1994 and December 1997. Interventions All the patients were evaluated using transvaginal sonography, hysteroscopy and endometrial biopsies. A total of 87 patients with polyps, myomas or an atrophic uterine cavity underwent polypectomy (n = 64) and myomectomy (n = 19) in association with endometrial resection (n = 87). Results Endometrial polyps and submucous myomas were the most frequent cause of uterine bleeding in postmenopausal women using HRT. These conditions could be treated effectively using the resectoscope. The failure rate of resectoscopic surgery for focal lesions in patients receiving HRT was 6%. Adenomyosis and recurrence of endometrial polyps were the most frequent reasons for treatment failure and resumption of vaginal bleeding. Conclusion Uterine bleeding caused by endometrial polyps and submucous myomas in menopausal patients using HRT can be effectively treated with the resectoscope.

Objective To compare the efficacy of suction curettage, hysteroscopy and transvaginal sonography in the diagnosis of endometrial polyps in both pre‐ and postmenopausal patients. Setting The study was carried out in a private hospital with facilities for endoscopic surgery. Design Comparative clinical study involving different techniques for the diagnosis of endometrial polyps in pre‐ and postmenopausal patients. Subjects 74 patients with endometrial polyps. Interventions Patients with abnormal transvaginal sonograms were submitted to diagnostic hysteroscopy to confirm the presence of polyps. A suction curettage using a 4‐ or 5‐mm Karman curette was carried out after hysteroscopy to obtain fragments of polyps for pathological examination. Polypectomy followed by endometrial resection was performed using the 27F resectoscope after the uterine cavity was aspirated using an 8‐mm Karman curette. Results The percentage of positive histopathological diagnoses of endometrial polyps was low whenever suction curettage was performed with a 4‐mm curette. The value increased to 80% when the 5‐mm curette was used to sample the uterine cavity in patients with a hysteroscopic diagnosis of polyps. The 8‐mm suction curette was effective in removing large fragments of polyps prior to polypectomy in all cases. Conclusion Suction curettage can be used to diagnose endometrial polyps in over 80% of patients, if curettes with diameters equal to or greater than 5 mm are used. Use of suction cannulae of less than 4 mm in diameter leads to the diagnosis of endometrial polyps being missed in 90% of cases.