Natural History of Uterine Polyps and Leiomyomata

Abstract

OBJECTIVE:To estimate the incidence and regression rates of uterine leiomyomata and polyps in a cohort of asymptomatic, premenopausal women. METHODS:Saline infusion sonography was performed twice, 2.5 years apart, in a cohort of 64 initially asymptomatic women. Subjects completed a questionnaire that assessed the development of abnormal uterine bleeding. RESULTS:The mean age of women (at second ultrasound) was 44 years. In four of seven women with polyps at the original ultrasound, their polyps regressed. Polyps that regressed tended to be smaller than polyps that persisted. Ten women had endometrial polyps at the second ultrasound for a point prevalence of 16% and a cumulative incidence rate of 12% per 2.5 years. A higher percentage of women with uterine polyps had complaints of abnormal uterine bleeding than women with no uterine abnormalities (70% versus 33%, P ‫؍‬ .04). Six leiomyomata in four women were no longer detected in the second ultrasound. Leiomyomata that regressed were in older premenopausal women and were smaller than leiomyomata that persisted. The point prevalence and incidence rates of leiomyomata were 27% and 13% per 2.5 years, respectively. Leiomyomata grew an average of 1.2 cm per 2.5 years, but great variation in growth rates were noted. CONCLUSION:Small uterine polyps frequently regressed spontaneously, whereas larger polyps were more likely to persist and were associated with the development of abnormal bleeding. Smaller leiomyomata in older premenopausal women also regressed whereas larger leiomyomata tended to grow while often remaining asymptomatic. (Obstet Gynecol 2002;100:3-7. Benign uterine lesions, such as endometrial polyps and leiomyomata, are common in women, especially those over age 35 years. 1-4 Submucosal leiomyomata or polyps are found in approximately 50% of premenopausal women referred for ultrasound evaluation of abnormal uterine bleeding. 1,5-7 However, the prevalence of both lesions is lower in nonselected populations of perimenopausal women being evaluated for their initial complaint of abnormal bleeding. 8 These lesions are also found in asymptomatic women. 1 Endometrial polyps and leiomyomata are frequently removed surgically because of their association with abnormal uterine bleeding. 1,9 Despite the high prevalence of these conditions and the morbidity attributed to them, little is known about their natural history.In 1999, using saline infusion sonography, we compared the prevalence of benign uterine lesions in 80 women with abnormal uterine bleeding to a cohort of 100 asymptomatic premenopausal women over age 30 years. 1 We detected polyps in 10% and leiomyomata in 13% of the asymptomatic controls. In our current study, we add to the understanding of the natural history of uterine polyps and leiomyomata. By reevaluating this group of initially asymptomatic women, we aimed to estimate the incidence rate and regression rate of uterine leiomyomata and polyps, as determined by saline infusion sonography. MATERIALS AND METHODSThis study was approved by the Universit...

Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

“…A remarkable finding in our study was that polyps were more frequent in women without AUB compared to women with AUB; 62 % of women with polyps were asymptomatic. The incidentally discovered polyps were reported to be 20-46.2 % [13,16]. On the other hand, Dreisler et al [17] found that the prevalence of uterine polyps among women without AUB was up to 82 % when women with myomas were excluded from analysis.…”

Epidemiology of Myomas

“…Notably, no fibroids were seen that regressed during their observations [22]. The disappearance or shrinking seen in other studies [20] may be caused by the imprecise nature of ultrasound examinations, where a fibroid could be incorrectly mapped or other features of the myometrium, such as a myometrial contraction, may be incorrectly scored as a fibroid, which might then later be seen to disappear.…”

“…Advancing age increases the risk for fibroids many fold, and mirrors the understanding of the biologic development of fibroids: most grow in time and are expected to be diagnosed in greater numbers in older cohorts. A small sample of patients who had their fibroids followed-up ultrasonographically [20] saw an average growth of 1.2 cm in 2.5 years. The chance of being diagnosed with fibroids increases with age until about 50 years and then declines sharply [8,11].…”

Demographic parameters of women with uterine fibroids presenting as abnormal uterine bleeding

“…19,20 Whether fibroids are symptomatic or not depends primarily on their size and on their position in relation to the uterine cavity. 21 Although the definitive management of gynecological symptoms attributable to uterine fibroids is surgical removal, many women decline surgery or prefer to pursue medical management. The natural history of fibroids is poorly understood, which makes it difficult to advise asymptomatic women with fibroids on the risk of developing clinical symptoms in the future.…”