Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy

Abstract

BackgroundAn endometrial polyp is a frequently encountered gynecologic disease with abnormal uterine bleeding and infertility being the two common presenting problems, and hysteroscopic polypectomy is an effective method to remove them. The postoperative polyp recurrence might result in reappearance of abnormal uterine bleeding or infertility, whereas factors influencing the postoperative recurrence potential have limited data.MethodsThis case-series report included 168 premenopausal women who suffered from endometrial polyps and underwent hysteroscopic polypectomy. All of them were awaiting a future pregnancy. Office hysteroscopy was done before and after hysteroscopic polypectomy, in which preoperative hysteroscopy examined the number, type, and location of endometrial polyps, and postoperative hysteroscopy checked the polyp recurrence. Surgical indications, either infertility or the presentation of abnormal uterine bleeding, and follow-up duration were recorded.ResultsSeventy-three out of 168 (43%) women had polyp recurrence after hysteroscopic polypectomy. Multivariate logistic regression analysis revealed that more endometrial polyps (P = 0.015) and longer duration of follow-up (P = 0.004) were significantly associated with an increased risk of postoperative polyp recurrence. The type of endometrial polyps was not correlated with polyp recurrence potential, whereas pedunculated type endometrial polyps were closely related to the presentation of abnormal uterine bleeding (P = 0.001).ConclusionsA higher number of endometrial polyps and longer follow-up duration are associated with a greater potential of polyp recurrence after hysteroscopic polypectomy.

CD4+ T cell imbalance is associated with recurrent endometrial polyps

“…Older age, obesity and hypertension have previously been identified as EP risk factors, but the precise underlying mechanism of how these factors may cause EP is unclear . Interestingly, CD4 + T cell imbalance toward the proinflammatory Th17 subtype was previously observed to increase with age and was present in patients with obesity and hypertension .…”

“…However, depending on the duration of the follow‐ups and the nature of the EP, 2.5%‐43.6% of patients present postoperative EP recurrence . Like the initial EP, little is known about the formation mechanism of recurrent EP, other than the observation that hyperplastic polyps are more likely to recur than benign polyps …”

“…CD4 + , endometrical polyps, T cell, Th17 mechanism of recurrent EP, other than the observation that hyperplastic polyps are more likely to recur than benign polyps. 5,7 The two demographic EP risk factors, aging and obesity, are currently known to associate with dysregulations in the immune system, [8][9][10] but it remains unclear whether the immune system is involved in EP development. Several studies have demonstrated that the local cellular environment and cytokine secretion were altered in EP.…”

Macrophages in patients with recurrent endometrial polyps could exacerbate Th17 responses

“…However, recurrent EP has been found and depending on the types of EP and the duration of the follow‐up appointments, the recurrence rate can range between 2.5% to 43.6% . Predictably, hyperplastic EPs have higher recurrence than benign EPs and are a more imminent threat to the patient's health …”

The possibilities of abundant uterine bleeding therapy with combined oral contraceptive containing estradiol valerate and dienogest (a review)

“…В последние годы рядом исследователей [19][20][21][22][23] подчеркивается роль медикаментозных методов лечения у пациенток с полипами эндометрия. Согласно рекомендациям общества минимальной инвазивной гинекологии (2012 г.…”