Prevalence Of Endometrial Polyps Research Articles

Advances in the Study of Pathological Histology and Pathogenesis of Endometrial Polyps

Endometrial polyps (EPs) are common gynecological diseases among women of childbearing age. They are formed by the proliferation of blood vessels and connective tissue in a portion of the endometrium, resulting in the formation of a polyp-like mass that protrudes into the uterine cavity and varies in size and number. Typically, the body of the uterus is the site of implantation of these polyp-like growths, which are attached to the medial wall of the uterine cavity by a long, thin tip. Irregular vaginal bleeding is the first clinical manifestation of endometrial polyps, and it can often lead to infertility. Studies have shown that the prevalence of endometrial polyps in the female population is approximately 25.0%. With the widespread use of hysteroscopic techniques in clinical practice, knowledge and diagnosis of endometrial polyps have significantly improved. However, pathological examination remains the “gold standard” for final diagnosis in clinical practice. This article aims to review the epidemiology, pathological histology, and pathogenesis of endometrial polyps to reveal their mechanisms and characteristics more accurately and guide further clinical research and treatment. The relevant progress in recent years in this field, both domestically and internationally, is reviewed below.

Hysteroscopic management of subfertility in cases with suspected endometrial polyps

Endometrial polyps (EPs) are a common benign gynecologic condition associated with abnormal uterine bleeding (AUB), infertility and recurrent pregnancy loss. Transvaginal ultrasound (TVU) provides an excellent diagnostic technique to identify the size and the anatomic location of endometrial polyps. Its accuracy increases when color Doppler, 3D investigation and saline-infused sonohysterography are used. However, hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps and provides a safe and feasible opportunity for EPs removal. Objectives. This study aims to demonstrate the effectiveness of hysteroscopic polyps’ removal in infertile young female patients. Methodology. This study, conducted over a period of one year, included women who addressed our clinic for infertility. These patients were clinically examined and evaluated using transvaginal ultrasound (TVUS). Hysteroscopy was performed on all cases where TVUS raised the suspicion of endometrial polyps. Additionally, the incidence of pregnancies obtained within the first 12 months after the hysteroscopic removal of endometrial polyps was recorded. Results. Out of the cohort of 97 infertile patients, endometrial polyps were suspected in 33 patients. Before hysteroscopy, seven patients additionally underwent a sonohysterography (SHG) procedure. Abnormal uterine bleeding was the primary clinical manifestation (21 cases; 63.63%). EPs were histologically confirmed in 31 cases, and leiomyoma, in two cases. Of the 31 EPs cases, in 20 cases (64.51%) the localization was at the utero-tubal junction. Out of the 30 patients diagnosed with EPs and where the follow-up was possible, 18 individuals, constituting 60% of the group, successfully attained intrauterine pregnancies within the initial 12 months following their hysteroscopic procedure. Conclusions. Our study revealed a significant improvement in reproductive outcomes within the first year following EP resection. The prevalence of endometrial polyps has increased due to improved ultrasound techniques. SHG can potentially increase the ultrasound detection of endometrial polyps, especially in cases where the imagistic information is unclear. Nonetheless, hysteroscopy, known for its high diagnostic accuracy, remains the gold standard. Our research supports the importance of hysteroscopy for uterine cavity assessment and lesion management, and it highlights the increased chances of pregnancy after the lesion’s removal.

Клинико-анамнестические факторы рецидивирующих полипов эндометрия в репродуктивном возрасте

The prevalence of endometrial polyps (EP) ranges from 7.8 to 34.9%, and in the group of patients with symptoms reaches 24%. The natural course of EP is unclear, the frequency of spontaneous regression of EP varies from 6.3% to 57.1%, but it is impossible to accurately predict the nature of the growth of an individual polyp and the probability of regression. A successful operation does not guarantee against recurrence of the disease: according to various authors, the frequency of postoperative recurrence of EP varies from 5.6% to 43.6%, depending on the duration of observa-tion and the nature of polyps. To improve the results of EP treatment, to determine the target groups for hysteroscopic polypectomy, it is impor-tant to have an understanding of the risk factors for recurrence of EP. The analysis of scientific publications in the databases eLibrary, PubMed, Cochrane Library, Science Direct was performed, according to the keywords endometrial polyps/endometrial polyp, recurrence/recurrence, risk factors/risk factors, reproductive age/reproductive age, premenopausal age/premenopausal age for 2013–2023. The obtained results of the liter-ature analysis allow us to conclude about the influence of age, multiple nature of polyps, chronic endometritis on the risk of recurrence of EP. In addition, other factors may be involved in the development of recurrent polyps. For a more accurate assessment of the contribution of various risk factors to the recurrence of EP, it is necessary to perform high-quality scientific research. The purpose of the work: to analyze the available literature data and summarize the information received to date on the clinical and anamnestic risk factors of EP.

Hysteroscopic alterations in women with infertility or recurrent spontaneous abortion in case of normal transvaginal ultrasonography

Introduction: Whether hysteroscopy should routinely be conducted before embryo transfer remains uncertain especially when transvaginal ultrasonography (TVS) is normal. We aimed to investigate the hysteroscopic findings for patients with infertility or recurrent spontaneous abortion and with normal TVS. Methods: Patients who underwent TVS and hysteroscopy in the hospital from January 2014 to May 2019 were enrolled. Propensity score matching (1:1) was carried out for TVS positive and negative result groups. The positive results of hysteroscopy in the primary and secondary infertility patients were further compared. The prevalence rates of various diseases in different age groups were summarized and analyzed. Results: A total of 1532 individuals were enrolled in the study group and 19,118 cases in the control group. A total of 1495 cases with TVS positive results were matched using propensity score matching (1:1). The prevalence of uterine diseases in the TVS positive group was significantly higher than that in the TVS negative group (P<0.001).The prevalence of endometrial polyps and endometrial hyperplasia in patients with primary infertility was significantly higher than that with secondary infertility (P<0.001). The diagnostic sensitivity of TVS for major uterine cavity diseases, confirmed by hysteroscopy was relatively low (12.7%; 11.9%–13.6%). Conclusions: Hysteroscopy can detect a considerable number of uterine lesions even after normal TVS results. The sensitivity of TVS for the diagnosis of intrauterine lesions is relatively low. We suggest that hysteroscopy be recommended for patients with infertility or recurrent spontaneous abortion.

An Ayurvedic Approach to a Case of Primary Infertility

Infertility is a multifactorial condition affecting both partners, of which the female contributes about 40% cases of infertile couples. Of all the various factors, the most frequently contributing factors are those of ovarian and uterine. Polycystic ovarian disease is the most common cause of an ovulatory infertility, being found in 75% of cases. It now proves to be a significant factor in female infertility with the prevalence of 0.6%–3.4% in infertile couples. While uterine or endometrial polyps are one among those that can affect the shape and functioning of the uterus, thereby leading to infertility. On an average, the prevalence of endometrial polyps can vary from 7.8% to 34.9%. The contemporary medical science extends hormonal and surgical intervention as the prime line of the management. Ayurvedic treatment modalities can bypass the surgical management to avoid the related burden and provide a fruitful outcome in such conditions. Here, we present a case of primary infertility with a known polycystic ovarian disease and sonologically diagnosed endometrial polyp. The case was successfully treated with Ayurvedic treatment modalities such as virechana karma, uttara basti, nasya karma, and shaman aushadi. The treatment course resulted in the regression of the polyp, re-established ovulation, and a successful conception with full-term normal labor.

Prevalencia de carcinoma en pólipos endometriales resecados por histeroscopia.

La prevalencia de pólipos endometriales (PE) es alrededor de 24% en la población femenina general y entre 10 y 30% en aquellas con hemorragia uterina anormal. Son lesiones de crecimiento rápido que pueden transformarse en una neoplasia maligna. Objetivo: determinar la frecuencia de cáncer endometrial en pacientes con PE diagnosticados por histeroscopia. Metodología: serie de casos retrospectivos atendidos en el Hospital de San José, Bogotá, Colombia, de 2005 a 2014. Resultados: se analizaron en total 408 historias clínicas de pacientes con diagnóstico histopatológico de PE, 10 (2.4%) presentaron patología premaligna y 9 (2,2%) lesión maligna confirmada por microscopía (endometrioides 6, seroso papilar 2 y carcinosarcoma 1). Todas las pacientes con patología maligna tenían más de 60 años y estaban en posmenopausia. Cuatro eran nulíparas, ninguna consumía tamoxifeno ni medicamentos hormonales Conclusión: la prevalencia de carcinomas endometriales en PE diagnosticados a través de histeroscopia en mujeres posmenopáusicas fue de 7.7%. Estos datos son similares a los reportados en la literatura, por lo que recomendamos la implementación de histeroscopia para el tratamiento de todos los PE y su riguroso estudio histopatológico.

Higher Prevalence of Endometrial Polyps in Patients with Fallopian Tube Obstruction: A Case-control Study

To study the association between endometrial polyps and fallopian tube patency diagnosed by hysteroscopy, conventional histology, and 4-dimensional (4D) hysterosalpingo-contrast sonography (HyCoSy). A case-control study (Canadian Task Force classification II-2). A university hospital. A total of 323 women of reproductive age underwent 4D HyCoSy and hysteroscopy between January 2015 and December 2017. A retrospective analysis of the association of endometrial polyps and fallopian tube obstruction (n = 154) or patency (n = 169) in patients who underwent 4D HyCoSy. The prevalence of endometrial polyps was significantly higher in patients with bilateral fallopian tube obstruction than in patients with bilateral fallopian tube patency (42.9% [66/154] vs 20.1% [34/169], p <.0001). In univariate and multivariate analyses, the presence of endometrial polyps was found to be a risk factor for tubal obstruction with an odds ratio of 3.16 and 2.59, respectively. The prevalence of endometrial polyps is higher in infertile patients with fallopian tube obstruction than in patients with fallopian tube patency. History of endometrial polyps, ectopic pregnancy, and pelvic inflammatory disease are risk factors for tubal obstruction.

Prevalence of Endometrial Polyps in Post-Menopausal Women without Abnormal Vaginal Bleeding

Prevalence of Endometrial Polyps in Post-Menopausal Women without Abnormal Vaginal Bleeding

OC25.02: Prevalence of endometrial polyps in asymptomatic premenopausal women

<scp>OC</scp>25.02: Prevalence of endometrial polyps in asymptomatic premenopausal women

Vascular markers CD31, CD34, actin, VEGFB, and VEGFR2, are prognostic markers for malignant development in benign endometrial polyps

Intention of the study: The prevalence of endometrial polyps has been demonstrated in between 10% and 35% of all women, but knowledge regarding malignant potential within polyps is limited. Even though premalignant and malignant changes have been reported in up to 24% of all cases, no objective tissue markers have ever been developed for routine diagnostics to select high risk cases. As vascular changes and activation of endometrial angiogenesis has been demonstrated in former studies, our main objective was to evaluate different members of the angiogenic pathway as potential risk factors for cancer development. Patients and methods: Formalin-fixed, paraffin-embedded tissue from 15 women with benign endometrial polyps, and 16 women diagnosed with endometrial cancer were included. Immunohistochemical investigation with antibodies against VEGF, VEGF-B, VEGFR2, VEGFR3, CD31, CD34, actin, and factorVIII was performed, followed by evaluation of staining intensity of microvessels, evaluation of H-score in glands (cell membrane, cytoplasm) and stroma, and measurement of micro vessel density. Results: Expression of CD31 in microvessels was significantly stronger in cancers compared to endometrial polyps (P = 0.006 for arterioles, P = 0.038, for venyles, and P = 0.002 for capillaries, respectively), whereas, a reverse change was shown for CD34. Expression of actin in capillary walls was also significantly increased in cancers compared to polyps (P = 0.002). No significant difference was found for staining intensity in microvessels (arterioles, venyles or capillaries) in endometrial benign polyps compared with endometrial cancers for VEGF, VEGFB, VEGFR2, VEGFR3, or Factor VIII. Also no difference in H-score values between benign polyps and endometrial cancers could be detected in glandular epithelium, in epithelial cell membrane or in stroma for VEGFR3, CD31 or Factor VIII. Conclusions: The present study strongly indicates that activation of angiogenesis differs in benign endometrial polyps and endometrial cancers. Thus, immunohistochemical expression of specific angiogenic markers may be of great importance as prognostic factors in the routine diagnostics of this lesion. The ratio between stromal expression of CD34 and actin might be of particular interest to select polyps with increased malignant potential.

Re: Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years

Objective To estimate the prevalence of endometrial polyps and to investigate associated abnormal uterine bleeding in a Danish population aged 20–74 years. Methods This was a study of a random selection of women from the Danish Civil Registration System: 1660 women were invited of whom 686 were included (429 pre- and 257 postmenopausal). AUB was assessed by a validated questionnaire. The women underwent transvaginal sonography (TVS) and saline contrast sonohysterography (SCSH). Hysteroscopic resection was performed in cases with suspected focal intrauterine pathology. Full evaluation was performed in 619 women (two failures of TVS and 60 failures of SCSH, in two women SCSH was contraindicated (endometrial cancer), in two women hysteroscopy was contraindicated, and one polyp was lost before histology). World Health Organization histopathological criteria were used for diagnosing true endometrial polyps. Results On final diagnosis there were 48 women with polyps, eight with submucosal myomas, four with other benign findings and one with polypoidal growing endometrial cancer. Complex hyperplasia without atypia was diagnosed in two women with polyps. The prevalence of endometrial polyps was 7.8% (48/619; 95% CI, 5.6–9.9%). The prevalence was influenced significantly by age (P < 0.005); in women below the age of 30 years, the prevalence was 0.9%. Polyps were diagnosed in 5.8% of pre- and 11.8% of postmenopausal women (P < 0.01). Thirty-nine (82%) of the women who had histopathologically verified polyps were asymptomatic. In asymptomatic premenopausal women the prevalence of polyps was 7.6%, while it was 13% in asymptomatic postmenopausal women. AUB, in particular intermenstrual bleeding, was more frequent among women without polyps (38%). By ultrasound examination, submucosal myomas were diagnosed in 4.2% (26/622; 95% CI, 2.6–5.8%) and intramural myomas in 11.1% (76/684; 95% CI, 8.8–13.5%) of women. Polyps were diagnosed in 2% of oral-contraceptive and 25% of hormone-therapy users. Conclusions The overall prevalence of endometrial polyps was 7.8% and the prevalence increased with age. Polyps were rare (0.9%) in women below the age of 30 years. Surprisingly, AUB was less frequent among women with polyps than among those without polyps. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years

To estimate the prevalence of endometrial polyps and to investigate associated abnormal uterine bleeding in a Danish population aged 20-74 years. This was a study of a random selection of women from the Danish Civil Registration System: 1660 women were invited of whom 686 were included (429 pre- and 257 postmenopausal). AUB was assessed by a validated questionnaire. The women underwent transvaginal sonography (TVS) and saline contrast sonohysterography (SCSH). Hysteroscopic resection was performed in cases with suspected focal intrauterine pathology. Full evaluation was performed in 619 women (two failures of TVS and 60 failures of SCSH, in two women SCSH was contraindicated (endometrial cancer), in two women hysteroscopy was contraindicated, and one polyp was lost before histology). World Health Organization histopathological criteria were used for diagnosing true endometrial polyps. On final diagnosis there were 48 women with polyps, eight with submucosal myomas, four with other benign findings and one with polypoidal growing endometrial cancer. Complex hyperplasia without atypia was diagnosed in two women with polyps. The prevalence of endometrial polyps was 7.8% (48/619; 95% CI, 5.6-9.9%). The prevalence was influenced significantly by age (P<0.005); in women below the age of 30 years, the prevalence was 0.9%. Polyps were diagnosed in 5.8% of pre- and 11.8% of postmenopausal women (P<0.01). Thirty-nine (82%) of the women who had histopathologically verified polyps were asymptomatic. In asymptomatic premenopausal women the prevalence of polyps was 7.6%, while it was 13% in asymptomatic postmenopausal women. AUB, in particular intermenstrual bleeding, was more frequent among women without polyps (38%). By ultrasound examination, submucosal myomas were diagnosed in 4.2% (26/622; 95% CI, 2.6-5.8%) and intramural myomas in 11.1% (76/684; 95% CI, 8.8-13.5%) of women. Polyps were diagnosed in 2% of oral-contraceptive and 25% of hormone-therapy users. The overall prevalence of endometrial polyps was 7.8% and the prevalence increased with age. Polyps were rare (0.9%) in women below the age of 30 years. Surprisingly, AUB was less frequent among women with polyps than among those without polyps.

Prevalence and characteristics of endometrial polyps in patients with abnormal uterine bleeding

The prevalence of endometrial polyps (EPs) in the general female population is about 24%. Abnormal uterine bleeding is frequently the presenting symptom of EPs. The aim of this study was to determine the prevalence and characteristics of EPs in patients with abnormal uterine bleeding. The prevalence and characteristics of EPs were investigated in 961 patients with abnormal uterine bleeding who underwent dilatation and curettage between January and December 2006. Regarding histopathological features of EPs (presence of atypical hyperplasia or endometrial carcinoma), patients were divided into two groups: group A--patients who had EPs and EPs with hyperplasia without atypia (n = 204) and group B--patients who had EPs with atypical hyperplasia and EPs with carcinoma (n = 7). In 211 (21.94%) patients EPs were found with abnormal uterine bleeding. Histopathologically, there were 175 (82.94%) EPs, 29 (13.74%) EPs with hyperplasia without atypia, 5 (2.37%) EPs with atypical hyperplasia, and 2 (0.95%) EPs with endometrial carcinoma. Contrary to the patients with EPs and EPs with hyperplasia without atypia (group A), patients who had EPs with atypical hyperplasia and EPs with carcinoma (group B) were older (p < 0.05), and more commonly postmenopausal (p < 0.05) and with hypertension (p < 0.05), all of statistical significance. The prevalence of endometrial polyps in patients with abnormal uterine bleeding according to our data was 21.95%. Atypical hyperplasia and endometrial carcinoma were rarely confined to a polyp. Older age, postmenopausal period and hypertension may increase the risk of premalignant and malignant changes in endometrial polyps.

The prevalence of endometrial polyps as diagnosed by saline infusion sonohysterography among different body mass indexes

To examine the association between the prevalence of endometrial polyps as diagnosed by saline infusion sonohysterography (SIS) and confirmed by pathology, among different Body Mass Index levels among couple presenting for an evaluation of infertility.

Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding

To compare the diagnostic accuracy and acceptability of transvaginal sonography (TVS), saline infusion sonography (SIS), and office hysteroscopy (OHS) for detecting intracavitary abnormalities in women with or without abnormal uterine bleeding (AUB). Prospective double-blind study. Zekai Tahir Burak Women's Health Education and Research Hospital, Gynecology Clinic (Ankara, Turkey). A total of 26 women with AUB and 24 women without AUB were enrolled in this study. Transvaginal sonography, SIS, and OHS were performed on women scheduled for hysterectomy. Sensitivity, specificity, and positive and negative predictive values of TVS, SIS, and OHS to detect intracavitary abnormalities (with histopathologic findings used as the gold standard), duration of procedure, and pain scores. The sensitivity and specificity of TVS, SIS, and OHS in detecting intracavitary abnormalities were 56.3% and 72%, 81.3% and 100%, and 87.5% and 100%, respectively. The prevalence of endometrial polyps was not different in women with and without AUB. Saline infusion sonography was less painful than OHS (pain scores of 4.3 and 7.2, respectively). The diagnostic accuracy of SIS was equal to that of OHS in diagnosing intracavitary abnormalities. Moreover, SIS was less painful than OHS for patients.