Analysis Of The Factors Associated With Endometrial Polyps

Objective Endometrial polyps(EPs) are one of most common diseases of endometrium. Prevention and treatments of EPs are gradually being given importance due to its effect on, fertility, potential malignant nature and high rate of recurrence. Clinical diagnosis rate has been increased due to generalized examination through hysteroscopy and improvement of ultrasound technology. However, there is big difference among results of different researches on etiology and mechanism of its prevalence and malignant transformation. A retrospective analysis was performed to explore risk factors for the development of EPs, and its malignant, transformation, the finding of this research can be used for screening of high risk patients and facilitate further researches on etiological mechanism.Methods A total of 592 patients were included in the study. All the patients had performed hysteroscopy and pathological examination during January 2012 to August 2014 at department of minimally invasive center for gynecology in our hospital. All the patients were divided in polyp group(385 cases) and non-polyp group(207 cases). Demographic data of all the patients were recorded in detail. Univariate and multivariate statistical analysis was performed by statistic software(SPSS 22.0 version).ResultAll together 385 patients(65%) were diagnosed as endometrial polyps. 269(69.9%) cases of EPs were found in women of 30-59 years age group. Among 385 cases of EPs, 193 patients(50.1%) had abnormal bleeding, 61(15.8%) were infertility patients, and 116 patients were symptomless. Among 385 cases, 5 cases(1.3%) were pre-malignant, and 1case(0.3%) was malignant(Endometrial adenocarcinoma). Univariate analysis revealed that patients' age, menopause status, diabetes mellitus, hypertension, adenomyosis and cervical polyps were significantly associated with EPs(P<0.05). While multivariate analysis showed significant association of EPs with patients' age(OR=1.049,Cl 95% 1.034-1.065,P<0.001) and adenomyosis(OR=2.456 CI 95% 1.151-4.012, P<0.001). Similarly, menopause status and obesity was significantly related with malignant EPs(P<0.05), however only menopause was found to be independent risk factor of malignant EPs(OR=4.954,CI=0.894-27.443,P=0.067). Among 37 cases of concomitant post-menopause abnormal bleeding and thickened endometrium(?5), 27 cases(73%) were benign(mainly EPs), only 5 cases(13.5%) were pre-malignant or malignant. There was no case of pre-malignant or malignant among 41 cases of asymptomatic patients with endometrial thickening. The incidence of malignant diseases was statistically significant(P=0.021,<0.05). Among 61 cases of infertile patients with EPs, 36 cases( 59%) had no obvious abnormalities in the pre-operative TVUS examination.Conclusion EPs were more prevalent in women of 30-50 years age group, abnormal bleeding and infertility were main clinical symptoms, asymptomatic patients also occupied a relatively higher proportion. Therefore, screening of asymptomatic patients with high risk factors is necessary in clinical works. Age and adenomyosis was independent risk factors for the development of EPs. Besides patients with menopause status, cervical polyps, DM and hypertension were also at high risk to have EPs. Hence, an extensive screening is necessary for these cohorts and further researches are required to understand its etiology. Malignancy rate of EPs was 1.6%, and menopause was its independent risk factor. Besides obesity(BMI>25) may also cause malignant transformation. Proper attention was required and histological examination is recommended for these patients. Benign pathology(mainly ploys) were more prevalent in postmenopause patients with thickened endometrium(?5mm) and(or) abnormal bleeding. Observational follow up is recommended for asymptomatic postmenopause patients with thickened endometrium if there are no other high risk factors present, as the endometrial malignancy rate was very low in this cases. Histological examination is recommended for post-menopause patients who had thickened endometrium and presented with abnormal bleeding, as there was risk of relatively high malignant transformation in these patients though benign cases were more prevalent. Hysteroscopy is necessary to rule out EPs for patients with infertility of unknown reasons, as TVUS examination was normal in numbers of infertile patients with EPs.