Prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding: A systematic review and meta-analysis

Abstract

There is wide variation in reporting the prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding. Most studies reported heterogenous populations of pre- and postmenopausal women both symptomatic and asymptomatic, making data interpretation difficult. The aim of this work is to quantify the prevalence of hyperplasia and cancer in polyps in women with postmenopausal bleeding aiming to produce data that help inform clinical practice as whether it is safer to remove all polyps, or some women could be offered expectant management. The search terms used were Medical Subject Headings terms, text words, truncations and word variations of the words or phrases ‘endometrial polyp’ or ‘uterine polyp’ or ‘womb polyp’ and ‘postmenopause’ or ‘menopause’. Search was limited to human studies and English language articles. Studies reporting separate analysis for women with postmenopausal bleeding were included. The included articles were assessed for risk of bias using the ‘Quality in Prognosis Studies’ tool. The prevalence was estimated with a random effect model using ‘DerSimonian and Laird’ method. The pooled estimate of prevalence of hyperplasia and cancer was 9% (95% confidence interval: 6.5%–11.5%). An I2 statistic of 77.2% suggests likely substantial heterogeneity. However, adjustment for small study effects had no influence on the pooled prevalence estimate suggesting no evidence for publication bias. Sensitivity analyses showed that no study exerted a big influence on the pooled estimate. The prevalence of hyperplasia and cancer in endometrial polyps in women with postmenopausal bleeding is high enough to warrant removal for accurate histopathological diagnosis.