Outpatient treatment for uterine polyps

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1469 (Published 23 March 2015) Cite this as: BMJ 2015;350:h1469
  1. Jan Bosteels, consultant12,
  2. Steven Weyers, professor of gynaecology3
  1. 1Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
  2. 2Centre for Evidence-Based Medicine, Belgian Branch of the Dutch Cochrane Centre, 3000 Leuven, Belgium
  3. 3Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to: J Bosteels jan.bosteels{at}med.kuleuven.be

A long overdue break with traditional practice, backed up by solid evidence

Abnormal uterine bleeding is one of the most common reasons why women present to hospital gynaecology departments. Even in developed countries such as Belgium1 a large proportion of these women are still being offered traditional dilatation and curettage combined with hysteroscopy under general anaesthesia, a costly approach that is inconvenient as it involves an overnight stay in hospital. The dominance of traditional inpatient dilatation and curettage is currently being challenged most recently by Cooper and colleagues in the linked study (doi:10.1136/bmj.h1398) evaluating outpatient diagnosis and treatment for women with uterine polyps, a common cause of intrauterine bleeding.2

During dilatation and curettage the operator is unable to see inside the uterine cavity, and tissue is therefore removed in a blind manner. The procedure is usually done to rule out endometrial cancer, and although the diagnostic accuracy for detecting endometrial cancer is high it is moderate for other endometrial disease, such as uterine polyps.3 Between 20% and 40% of women with abnormal uterine bleeding have polyps. Hysteroscopy allows the operator to visualise the entire uterine …

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