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Wait-and-See Approach Backed for Small Uterine Growths

Study finds many go away without causing symptoms

MONDAY, July 1, 2002 (HealthDayNews) -- Less may be more when it comes to treating small, noncancerous uterine growths such as polyps or fibroid tumors.

That's the conclusion of a new study, which finds that many of these small growths will simply disappear on their own.

The study, the first ever to document the natural progression of polyps, appears in the July issue of Obstetrics & Gynecology. Experts say it is good news for women who want to avoid surgery, which is currently the most commonly recommended treatment for these uterine abnormalities.

"If the polyp or fibroid is small and the woman is not experiencing any symptoms, then taking a wait-and-see approach is justified," says Dr. Bradley J. Van Voorhis, study author and a professor of reproductive endocrinology at the University of Iowa College of Medicine.

For Dr. Steven Goldstein, who was not part of the study but whose own research was quoted in the new report, the results are encouraging even though they raise some doubts.

"Certainly, this study validates the importance of taking a conservative wait-and-see approach," Goldstein says. However, he's also concerned the imaging was so detailed "it may have caused ordinary irregularities in the topography of the uterus to appear like tiny growths even though they weren't there."

As a woman has menstrual periods, that topography can change, Goldstein explains, which may account for why what seemed like tiny growths also seemed to disappear.

What made this study possible was the use of ultra-detailed imaging via saline sonography. This method takes the ordinary ultrasound one step further, with the addition of a harmless saline solution injected into the uterus just before the imaging is performed. That solution, which seeps into the tiny nooks and crannies of the uterus, has the ability to lift and illuminate any irregular surfaces, making it easier to spot even the tiniest of uterine abnormalities.

Van Voorhis says the extensive experience of the sonographers involved in the study, coupled with such clear pictures, let them determine the growths were indeed polyps and fibroid tumors, albeit small ones.

"Clearly, the smaller the polyp or fibroid upon first exam, the greater the likelihood that it would regress by the second exam," Van Voorhis says.

While the authors say they are not certain how the smaller growths may have disappeared, Van Voorhis believes that two of the four patients with polyps may have passed those growths during what they described as exceptionally heavy menstrual periods. The same may be true for the women who had the fibroid tumors.

"Before we had such high-definition diagnostic tools, it's my guess that many women had polyps or fibroid tumors which regressed on their own -- and that they perhaps passed them during what they would describe as the occasional heavy period," he says.

The new study involved just 64 women whose average age was 44. Each received two saline sonograms some 2.5 years apart. During that time, the women also completed "symptom" questionnaires designed primarily to assess episodes of abnormal uterine bleeding, a significant indication of polyps or fibroid tumors.

Seven women were found to have polyps during the first ultrasound exam, while 11 others were diagnosed with a total of 18 fibroid tumors.

By the second exam, four of the seven women diagnosed with polyps no longer showed any sign of the growths. Additionally, six fibroid tumors initially diagnosed in four women during the first exam were no longer present during the second exam.

"Clearly, there was a regression in these women," Van Voorhis says. "But I should point out that the polyps and the fibroid tumors that regressed were small, while the ones which were larger upon the first ultrasound were, by and large, still present."

Either way, Van Voorhis believes his study clearly demonstrates that just because doctors have the ability to find these growths earlier "we should not equate better diagnostics with a need for earlier surgical intervention, particularly if the woman is not having any bothersome symptoms."

What To Do

For a fact sheet on saline sonography, visit Phillips Medical Systems.

For more information on polyps, try this page at About.com. To learn more about fibroid tumors, visit Fibroid-Choice.com.

SOURCES: Bradley J. Van Voorhis, M.D., professor, reproductive endocrinology, University of Iowa College of Medicine, Iowa City; Steven Goldstein, M.D., professor, obstetrics and gynecology, New York University School of Medicine, New York City; July 2002 Obstetrics & Gynecology
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