Volume 20, Issue 6 (June 2022)                   IJRM 2022, 20(6): 461-468 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Aflatoonian A, Pezeshkpour Z, Mehrolhasani Y, Tabibnejad N. The effect of misoprostol on the removal of endometrial polyps: A pilot clinical trial. IJRM 2022; 20 (6) :461-468
URL: http://ijrm.ir/article-1-2096-en.html
The effect of misoprostol on the removal of endometrial polyps: A pilot clinical trial
Abbas Aflatoonian1 , Zohreh Pezeshkpour * 2, Yasamin Mehrolhasani1 , Nasim Tabibnejad1
1- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences. Yazd, Iran.
2- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences. Yazd, Iran. , z.pezeshkpour@stu.ssu.ac.ir
Abstract:   (1217 Views)
Background: Endometrial polyps are one of the most common gynecological disorders with a high frequency among infertile women. Hysteroscopic polypectomy remains the gold standard for the treatment of endometrial polyps. As alternative treatments, few drugs have been evaluated to date.
Objective: To investigate the possible effect of misoprostol on the elimination of endometrial polyps.
Materials and Methods: In this clinical trial we examined 30 infertile women whose endometrial polyps were confirmed by both transvaginal ultrasound with color Doppler and sonography with saline injection. All women were administered 400 mg of misoprostol: 200 mg orally and 200 vaginally. 8 hr later, sonography with saline injection was performed again and all women were examined for the presence or absence of endometrial polyps. Finally, the diagnosis was confirmed for all women using hysteroscopy. The main outcome of this study was the elimination of endometrial polyps after misoprostol administration.
Results: The average size of the endometrial polyps was 14.33 ± 4.26 mm, with a range of 7-22 mm. After misoprostol administration, in 12 out of the 30 women who had shown endometrial polyps in the initial examination, no polyp was found. At follow-up it was found that the smallest endometrial polyp that had been eliminated was 8 mm and the largest was 22 mm.
Conclusion: The findings of our study revealed that misoprostol can remove up to 40% of endometrial polyps. This drug has the potential to be used as a safe and low-cost first-line treatment before performing hysteroscopic polypectomy.
Keywords: Endometrial polyps, Misoprostol, Saline infusion sonohysterography, Transvaginal color Doppler, Infertility.
Full-Text [PDF 607 kb]   (962 Downloads) |   |   Full-Text (HTML)  (315 Views)  
Type of Study: Original Article | Subject: Fertility & Infertility
References
1. Gu F, Zhang H, Ruan S, Li J, Liu X, Xu Y, et al. High number of endometrial polyps is a strong predictor of recurrence: Findings of a prospective cohort study in reproductive-age women. Fertil Steril 2018; 109: 493-500. [DOI:10.1016/j.fertnstert.2017.11.029] [PMID]
2. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med 2019; 7: 2050312119848247. [DOI:10.1177/2050312119848247] [PMID] [PMCID]
3. Yuksel S, Tuna G, Celik HG, Salman S. Endometrial polyps: Is the prediction of spontaneous regression possible? Obstet Gynecol Sci 2021; 64: 114-121. [DOI:10.5468/ogs.20242] [PMID] [PMCID]
4. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol 2004; 94: 256-266. [DOI:10.1016/j.ygyno.2004.03.048] [PMID]
5. Onalan R, Onalan G, Tonguc E, Ozdener T, Dogan M, Mollamahmutoglu L. Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization. Fertil Steril 2009; 91: 1056-1060. https://doi.org/10.1016/j.fertnstert.2008.01.002 [DOI:10.1016/j.fertnstert.2009.03.016] [PMID]
6. Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: A critical review of the literature. J Minim Invasive Gynecol 2011; 18: 569-581. [DOI:10.1016/j.jmig.2011.05.018] [PMID]
7. Preutthipan S, Herabutya Y. Hysteroscopic polypectomy in 240 premenopausal and postmenopausal women. Fertil Steril 2005; 83: 705-709. [DOI:10.1016/j.fertnstert.2004.08.031] [PMID]
8. Shokeir TA, Shalan HM, El-Shafei MM. Significance of endometrial polyps detected hysteroscopically in eumenorrheic infertile women. J Obstet Gynaecol Res 2004; 30: 84-89. [DOI:10.1111/j.1447-0756.2003.00163.x] [PMID]
9. Varasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol 1999; 94: 168-171. https://doi.org/10.1016/S0029-7844(99)00278-1 [DOI:10.1097/00006250-199908000-00002]
10. Al-Jefout M, Black K, Schulke L, Berbic M, Luscombe G, Tokushige N, et al. Novel finding of high density of activated mast cells in endometrial polyps. Fertil Steril 2009; 92: 1104-1106. [DOI:10.1016/j.fertnstert.2009.02.016] [PMID]
11. Inagaki N, Ung L, Otani T, Wilkinson D, Lopata A. Uterine cavity matrix metalloproteinases and cytokines in patients with leiomyoma, adenomyosis or endometrial polyp. Eur J Obstet Gynecol Reprod Biol 2003; 111: 197-203. [DOI:10.1016/S0301-2115(03)00244-6]
12. Martinez-Perez O, Perez-Medina T, Bajo-Arenas J. Ultrasonography of endometrial polyps. Ultrasound Rev Obstet Gynecol 2003; 3: 43-50.
13. American Association of Gynecologic Laparoscopists. AAGL practice report: Practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol 2012; 19: 3-10. [DOI:10.1016/j.jmig.2011.09.003] [PMID]
14. Schorge JO, Hoffman BL, Bradshaw KD, Cunningham FG. Abnormal uterine bleeding. Williams Gynecology. Columbus: McGraw-Hill Professional; 2008.
15. Anioł M, Dec G, Wojda K, Sieroszewski P. Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis. Ginekol Pol 2017; 88: 285-288. [DOI:10.5603/GP.a2017.0054] [PMID]
16. de Kroon CD, de Bock GH, Dieben SW, Jansen FW. Saline contrast hysterosonography in abnormal uterine bleeding: A systematic review and meta-analysis. BJOG 2003; 110: 938-947. https://doi.org/10.1111/j.1471-0528.2003.02472.x [DOI:10.1016/S1470-0328(03)02472-8] [PMID]
17. Schwärzler P, Concin H, Bösch H, Berlinger A, Wohlgenannt K, Collins WP, et al. An evaluation of sonohysterography and diagnostic hysteroscopy for the assessment of intrauterine pathology. Ultrasound Obstet Gynecol 1998; 11: 337-342. [DOI:10.1046/j.1469-0705.1998.11050337.x] [PMID]
18. Widrich T, Bradley LD, Mitchinson AR, Collins RL. Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol 1996; 174: 1327-1334. [DOI:10.1016/S0002-9378(96)70680-4]
19. Ludwin A, Lindheim SR, Booth R, Ludwin I. Removal of uterine polyps: Clinical management and surgical approach. Climacteric 2020; 23: 388-396. [DOI:10.1080/13697137.2020.1784870] [PMID]
20. Abdollahi Fard S, Mostafa Gharabaghi P, Montazeri F, Mashrabi O. Hysteroscopy as a minimally invasive surgery, a good substitute for invasive gynecological procedures. Iran J Reprod Med 2012; 10: 377-382.
21. Pereira N, Petrini AC, Lekovich JP, Elias RT, Spandorfer SD. Surgical management of endometrial polyps in infertile women: A comprehensive review. Surg Res Pract 2015; 2015: 914390. [DOI:10.1155/2015/914390] [PMID] [PMCID]
22. Reslová T, Tosner J, Resl M, Kugler R, Vávrová I. Endometrial polyps: A clinical study of 245 cases. Arch Gynecol Obstet 1999; 262: 133-139. [DOI:10.1007/s004040050241] [PMID]
23. Vercellini P, Trespidi L, Bramante T, Panazza S, Mauro F, Crosignani PG. Gonadotropin releasing hormone agonist treatment before hysteroscopic endometrial resection. Int J Gynaecol Obstet 1994; 45: 235-239. [DOI:10.1016/0020-7292(94)90248-8]
24. Wada-Hiraike O, Osuga Y, Hiroi H, Fujimoto A, Maruyama M, Yano T, et al. Sessile polyps and pedunculated polyps respond differently to oral contraceptives. Gynecol Endocrinol 2011; 27: 351-355. [DOI:10.3109/09513590.2010.492884] [PMID]
25. Allen R, O'Brien BM. Uses of misoprostol in obstetrics and gynecology. Rev Obstet Gynecol 2009; 2: 159-168.
26. Tang OSh, Ho PC. The pharmacokinetics and different regimens of misoprostol in early first-trimester medical abortion. Contraception 2006; 74: 26-30. [DOI:10.1016/j.contraception.2006.03.005] [PMID]
27. Celik H, Sapmaz E, Serhatlioglu S, Parmaksiz C, Altingul A. Effect of intravaginal misoprostol use on uterine artery blood flow in patients with myoma uteri. Fertil Steril 2003; 80: 1526-1528. [DOI:10.1016/j.fertnstert.2003.05.017] [PMID]
28. Batukan C, Ozgun MT, Ozcelik B, Aygen E, Sahin Y, Turkyilmaz C. Cervical ripening before operative hysteroscopy in premenopausal women: A randomized, double-blind, placebo-controlled comparison of vaginal and oral misoprostol. Fertil Steril 2008; 89: 966-973. [DOI:10.1016/j.fertnstert.2007.03.099] [PMID]
29. Oppegaard KS, Nesheim BI, Istre O, Qvigstad E. Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design. BJOG 2008; 115: 663. [DOI:10.1111/j.1471-0528.2007.01628.x] [PMID] [PMCID]
30. Waddell G, Desindes S, Takser L, Beauchemin MC, Bessette P. Cervical ripening using vaginal misoprostol before hysteroscopy: A double-blind randomized trial. J Minim Invasive Gynecol 2008; 15: 739-744. https://doi.org/10.1016/j.jmig.2008.09.451 [DOI:10.1016/j.jmig.2008.08.013] [PMID]
31. Chowdary P, Maher P, Ma T, Newman M, Ellett L, Readman E. The role of the mirena intrauterine device in the management of endometrial polyps: A pilot study. J Minim Invasive Gynecol 2019; 26: 1297-1302. [DOI:10.1016/j.jmig.2018.12.013] [PMID]
32. Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod 1997; 12: 1768-1771. [DOI:10.1093/humrep/12.8.1768] [PMID]
33. Jakab A, Ovári L, Juhász B, Birinyi L, Bacskó G, Tóth Z. Detection of feeding artery improves the ultrasound diagnosis of endometrial polyps in asymptomatic patients. Eur J Obstet Gynecol Reprod Biol 2005; 119: 103-107. [DOI:10.1016/j.ejogrb.2004.06.044] [PMID]
34. Bernard JP, Rizk E, Camatte S, Robin F, Taurelle R, Lecuru F. Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders. Ultrasound Obstet Gynecol 2001; 17: 145-149. [DOI:10.1046/j.1469-0705.2001.00336.x] [PMID]
35. Valenzano MM, Lijoi D, Mistrangelo E, Fortunato T, Costantini S, Ragni N. The value of sonohysterography in detecting intracavitary benign abnormalities. Arch Gynecol Obstet 2005; 272: 265-268. [DOI:10.1007/s00404-005-0016-z] [PMID]
36. Pasqualotto EB, Margossian H, Price LL, Bradley LD. Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction. J Am Assoc Gynecol Laparosc 2000; 7: 201-209. [DOI:10.1016/S1074-3804(00)80041-9]
37. Preutthipan S, Linasmita V. A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. J Obstet Gynaecol Res 2003; 29: 33-37. [DOI:10.1046/j.1341-8076.2003.00068.x] [PMID]
38. Mansour T, Chowdhury YS. Endometrial polyp. Stat-Pearls. Treasure. Island (FL): StatPearls Publishing; 2020.
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb