Fatores preditivos para a ocorrência de pólipos endometriais em mulheres na pós-menopausa

Abstract

ResumoOBJETIVO: Avaliar os fatores clínicos preditivos para o desenvolvimento dos pólipos endometriais em mulheres na pós-menopausa. MÉTODOS: Estudo de coorte observacional com mulheres na pós-menopausa, que haviam sido atendidas em hospital público universitário. Dados clínicos, antropométricos, laboratoriais e ultrassonográficos de 132 pacientes com diagnóstico anatomopatológico de pólipo endometrial e de 264 mulheres sem alterações endometriais (controle) foram comparados para avaliar os fatores preditivos do pólipo endometrial. Foram incluídas no estudo mulheres com amenorreia ≥12 meses e idade ≥45 anos, em uma proporção de 1 caso para 2 controles. Para a análise estatística, foram empregados os testes t de Student, χ 2 e regressão logística -odds ratio (OR). RESULTADOS: As pacientes com pólipo endometrial apresentaram idade mais avançada e maior tempo de menopausa quando comparadas ao controle (p<0,0001). A porcentagem de mulheres obesas com pólipo (72,0%) foi superior à do Grupo Controle (39%; p<0,0001). A medida da circunferência da cintura foi superior entre as pacientes com pólipo (p=0,0001). Observou-se uma incidência de diabetes, hipertensão e dislipidemias mais elevada nas pacientes com pólipo endometrial (p<0,0001). De acordo com os critérios do US National Cholesterol Education Program/ Adult Treatment Panel III (NCEP/ATP III), 48,5% das mulheres com pólipo e 33,3% do Grupo Controle foram classificadas como portadoras de síndrome metabólica (p=0,004). Em relação ao Grupo Controle, apresentaram maior chance de desenvolvimento de pólipo endometrial as pacientes com: IMC≥25 kg/m 2 (OR=4,6; IC95% 2,1-10,0); glicose ≥100 mg/dL (OR=2,8; IC95% 1,3-5,9); dislipidemia (OR=7,0; IC95% 3,7-13,3); diabetes (OR=2,5; IC95% 1,0-6,3) e síndrome metabólica (OR=2,7; IC95% 1,1-6,4). CONCLUSÃO: Em mulheres na pós-menopausa, obesidade, dislipidemia, hiperglicemia e presença de síndrome metabólica foram fatores preditivos para o desenvolvimento de pólipo endometrial.Abstract PURPOSE: To evaluate the predictive clinical factors for the development of endometrial polyps in postmenopausal women. METHODS: Observational cohort study with postmenopausal women who had been at a public university hospital. Clinical, anthropometrical, laboratorial, and ultrasonographic data of 132 patients with a histopathological diagnosis of endometrial polyps and 264 women without endometrial alterations (control) were compared in order to evaluate the predictive factors of endometrial polyps. Women with amenorrhea ≥12 months and ≥45 years of age were included in the study at a proportion of 1 case for 2 controls. The Student's t-, χ 2 , and logistic regression tests were used for statistical analysis -odds ratio (OR). RESULTS: Patients with endometrial polyps were older and had been in menopause for a longer time compared to control (p<0.0001). The percentage of obese women with polyps (72.0%) was higher compared to the Control Group (39%; p<0.0001). The measurement of waist circumference was superior among patients with polyps

Immunohistochemical expression of hormone receptors, Ki-67, endoglin (CD105), claudins 3 and 4, MMP -2 and -9 in endometrial polyps and endometrial cancer type I

“…The pathogenesis of EP is still not completely understood, and there is still debate regarding the management of this condition, particularly in postmenopausal asymptomatic women. 2 , 3 , 29 The risk factors for malignancy in EP are the same as those reported for EC, namely advanced age, nulliparity, early menarche, late menopause, obesity, hypertension, diabetes, and use of tamoxifen. 3 , 6 , 30 …”

“… 1 They can be associated with abnormal uterine bleeding and are estimated to be responsible for up to 39% of cases of irregular bleeding during menacme and 21%–28% of cases of postmenopausal bleeding. 2 , 3 In the general population, the prevalence of EP is reported to range from 25% to 30%, with an incidence peak in women aged 40–60 years. After menopause, EP prevalence is twofold higher (11.8%) than during menacme (5.8%).…”

“… 4 – 6 The preponderance of polyps at perimenopause and in the first year after menopause, added to the inconvenience represented by potential bleeding episodes, indicates that EP is an important condition in the differential diagnosis of endometrial cancer (EC). 2 , 3 …”