Incidence of Endometrial Polyp in Postmenopausal Patients Undergoing Diagnostic Hysteroscopy, with Prior Ultrasound Indicating Endometrial Thickening at a University Hospital in Belo Horizonte: A Prospective Study

Abstract

Introduction: Endometrial polyps (EP) are prevalent in postmenopausal women and pose a risk factor for endometrial cancer. Transvaginal ultrasound (TVUS) has low accuracy in detecting EP, leading to diagnostic failures, whereas diagnostic hysteroscopy (DH) is more effective and allows for biopsy and removal of lesions, making it crucial for diagnosis and management. Objective: To evaluate the prevalence of EP in patients undergoing hysteroscopy with a prior diagnosis of endometrial thickening on TVUS. Methodology: This is a prospective, cross-sectional observational study conducted at a University Hospital in Belo Horizonte, which included postmenopausal women undergoing DH between October 2023 and June 2024. Results: Data collection encompassed 252 patients aged between 38 and 82 years, of whom 141 were postmenopausal (55%). Among these, 79 exhibited endometrial thickening on TVUS, and 62 (78.5%) were diagnosed with polyps upon DH. It was observed that 69% had endometrial thickening between 6-10 mm, and 30% had thickening greater than 10 mm. Twenty-one percent of the patients had a prior finding of polyps on TVUS, confirmed by DH. Of these, approximately 45% experienced pelvic pain, 34% complained of abnormal uterine bleeding, and 39% were asymptomatic. Following examinations, 49% were referred for surgical hysteroscopy, 25% for biopsy, and 1.6% had inconclusive results. Conclusion: The study confirms a high incidence of endometrial polyps in hysteroscopy in postmenopausal women and highlights its superiority over TVUS for diagnosis, underscoring the importance of DH as the gold standard for polyp diagnosis.

Keywords: Hysteroscopy; Ultrasound; Postmenopause.