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Release: July 2, 2002

UI study finds some uterine polyps and fibroids can regress on their own

Benign uterine polyps and fibroids occur in many women, especially those over age 35, and often are surgically removed, particularly if they are causing abnormal bleeding. However, the natural history of these lesions has not been studied. Some uterine polyps and fibroids regress on their own without surgery, according to findings by University of Iowa Health Care investigators.

The researchers found in four of seven women with asymptomatic polyps that the lesions regressed or went away on their own without treatment. Smaller growths were more likely than larger growths to spontaneously resolve. The findings appear in the lead article of the July 1 issue of the journal Obstetrics and Gynecology.

"Despite the fact the endometrial polyps are very common, no one had ever reported on the natural history of these lesions," said Bradley Van Voorhis, M.D., UI professor of obstetrics and gynecology and the study's principal investigator.

The UI team followed the cases of 64 initially asymptomatic women (average age 44) over two-and-a-half years to track the development and regression of uterine abnormalities of polyps, which are benign growths on the tissue lining the inside of the uterus, and fibroids, also known as leiomyomata, which are benign tumors in the smooth muscle of the uterus.

The team used saline infusion sonography to monitor the condition of the women's lesions and thus detect the lesions and record either growth or regression of the lesions. Saline infusion sonography involves using ultrasound and injecting fluid into the uterine cavity to better see the polyps and fibroids. Seven of the 64 women had endometrial polyps at the first examination, and four of these women had no polyps detected at their second examination. Eleven of the 64 women had a total of 18 fibroids at the first ultrasound, and among these 11 women, one had no fibroids at the second examination. The polyps were more likely than the fibroids to resolve on their own.

"We found in some asymptomatic women that over time the growths no longer were present," Van Voorhis said. "This natural regression is something physicians should take into consideration when they might otherwise recommend surgery to women who have no bleeding or other symptoms. If a small polyp is asymptomatic, there is no reason to take it out. In addition, our findings in asymptomatic polyps raise questions about what would happen with small symptomatic polyps if they were left alone rather than surgically removed."

Typically, the surgical treatment is offered on an outpatient basis and can involve general anesthesia. Van Voorhis said that fewer surgeries would mean less expense and time spent by the patient.

"Surgery is effective, but we do wonder how many women would be happy if their condition was left alone to resolve itself without treatment," Van Voorhis said.

In addition to Van Voorhis, UI investigators contributing to the study included Deborah DeWaay, now a second-year student in the UI Roy J. and Lucille A. Carver College of Medicine; and UI Department of Obstetrics and Gynecology faculty members Craig Syrop, M.D., professor; Ingrid Nygaard, M.D., associate professor; and William Davis, M.D., assistant professor (clinical).

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