To the content
3 . 2022

Causes of endometrial polyps in women of reproductive age

Abstract

The most common pathology of the uterine cavity is endometrial polyps. Uterine cavity polyps are most common in the reproductive and premenopausal periods. However, at the moment, there is not enough data concerning the causes of endometrial polyps in women in the reproductive period. Given this fact, the objectives of this study were determined. Among the scientific papers, a search was conducted in the databases – PubMed, Cochrane Library, Science Direct, by keywords (polyps, endometrium, causes of appearance, reproductive age) for 2000–2022. According to the analysis of scientific papers, we have identified the following conclusions:

1. The causes of endometrial polyps depend on several factors, including hormonal, metabolic, medicinal, genetic.

2. The influence of estrogens, hyperestrogenemia, age, play an important role in the causes of endometrial polyps in women of reproductive age

3. The true frequency of endometrial polyps more often depends on the studied population and the real prevalence is difficult to determine due to the act that endometrial polyps can exist asymptomatically for a long time and regress after time.

Keywords:causes; polyps; appearance; endometrium; reproductive age; review

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Orazov M.R., Mihaleva L.M., Poymanova O.F. Causes of endometrial polyps in women of reproductive age. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2022; 10 (3): 72–7. DOI: https://doi.org/10.33029/2303-9698-2022-10-3-72-77 (in Russian)

REFERENCES

1. Tanos V., Berry K.E., Seikkula J., Abi Raad E., Stavroulis A., Sleiman Z. The management of polyps in female reproductive organs. Int J Surg. 2017; 43: 7–16. DOI: https://doi.org/10.1016/j.ijsu.2017.05.012

2. Yuksel S. Endometrial polyps: Is the prediction of spontaneous regression possible? Obstet Gynecol Sci. 2021; 64 (1): 114–21. DOI: https://doi.org/10.5468/ogs.20242

3. Chernukha G.E., Asaturova A.V., Ivanov I.A., Dumanovskaya M. R. The structure of endometrial pathology in various age periods. Akusherstvo i ginekologiya [Obstetrics and Gynecology]. 2018; (8): 129–35. DOI: https://doi.org/10.18565/aig.2018.8.129-134 (in Russian)

4. Capmas P., Pourcelot A.G., Giral E., Fedida D., Fernandez H. Office hysteroscopy: a report of 2402 cases. J Gynecol Obstet Biol Reprod (Paris). 2016; 45: 445–50. DOI: https://doi.org/10.1016/j.jgyn.2016.02.007

5. Dreisler E., Stampe Sorensen S., Ibsen P.H., Lose G. Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years. Ultrasound Obstet Gynecol. 2009; 33: 102–8. DOI: https://doi.org/10.1002/uog.6259

6. Moon S.H., Lee S.E., Jung I.K. A giant endometrial polyp with tamoxifen therapy in postmenopausal woman. Korean J Obstet Gynecol. 2011; 54 (12): 836–40. DOI: https://doi.org/10.5468/KJOG.2011.54.12.836

7. Bakour S.H., Khan K.S., Gupta J.K. The risk of premalignant and malignant pathology in endometrial polyps. Acta Obstet Gynecol Scand. 2000; 79 (4): 317–20. PMID: 10746849.

8. Lopes R.G., Baracat E.C., de Albuquerque Neto L.C. Analysis of estrogen- and progesterone-receptor expression in endometrial polyps. J Minim Invasive Gynecol. 2007; 14 (3): 300–3. DOI: https://doi.org/10.1016/j.jmig.2006.10.022

9. Mittal K., Schwartz L., Goswami S. Estrogen and progesterone receptor expression in endometrial polyps. Int J Gynecol Pathol. 1996; 15 (4): 345–8. DOI: https://doi.org/10.1097/00004347-199610000-00007

10. Chan S.S., Tam W.H., Yeo W. A randomised controlled trial of prophylactic levonorgestrel intrauterine system in tamoxifen-treated women. BJOG. 2007; 114 (12): 1510–5. DOI: https://doi.org/10.1111/j.1471-0528.2007.01545.x

11. Nijkang N.P. Endometrial polyps: pathogenesis, sequelae and treatment. SAGE Open Med. 2019; 7: 1–12. DOI: https://doi.org/10.1177/2050312119848247

12. McGurgan P., Taylor L.J., Duffy S.R. Does tamoxifen therapy affect the hormone receptor expression and cell proliferation indices of endometrial polyps? An immunohistochemical comparison of endometrial polyps from postmenopausal women exposed and not exposed to tamoxifen. Maturitas. 2006; 54 (3): 252–9. DOI: https://doi.org/10.1016/j.maturitas.2005.11.007

13. Gokmen Karasu A.F., Sonmez F.C., Aydin S. Survivin expression in simple endometrial polyps and tamoxifen-associated endometrial polyps. Int J Gynecol Pathol. 2018; 37 (1): 27–31. DOI: https://doi.org/10.1097/PGP.0000000000000376

14. Goldstein S.R. Unusual ultrasonographic appearance of the uterus in patients receiving tamoxifen. Am J Obstet Gynecol. 1994; 170 (2): 447–51. DOI: https://doi.org/10.1016/s0002-9378(94)70209-8

15. Oguz S., Sargin A., Kelekci S., Aytan H., Tapisiz O.L., Mollamahmutoglu L. The role of hormone replacement therapy in endometrial polyp formation. Maturitas. 2005; 50: 231–6. DOI: https://doi.org/10.1016/j.maturitas.2004.06.002

16. Hassa H. Independent risk factors for endometrial polyps: diabetes, hypertension, and obesity. Asian Pac J Reprod. 2012; 1 (4): 312–4. DOI: https://doi.org/10.1016/S2305-0500(13)60099-8

17. Nappi L., Indraccolo I. Are diabetes, hypertension, and obesity independent risk factors for endometrial polyps? J Minim Invasive Gynecol. 2009; 16 (2): 157–62. DOI: https://doi.org/10.1016/j.jmig.2008.11.004

18. Gregoriou O., Konidaris S., Vrachnis N. Clinical parameters linked with malignancy in endometrial polyps. Climacteric. 2009; 12 (5): 454–8. DOI: https://doi.org/10.1080/13697130902912605

19. Bagdasaryan L.Yu., Ponomarev V.V., Karakhalis L.Yu., Steblo E.I., Pen- zhoyan G.A. Factors influencing the development of endometrial polyps. Kubanskiy nauchniy meditsinskiy vestnik [Kuban Scientific Medical Bulletin]. 2018; 25 (2): 25–8. DOI: https://doi.org/10.25207/1608-6228-2018-25-2-25-28 (in Russian)

20. Tabrizi A.D. Histologic features and differential diagnosis of endometrial polyps; an update and review. Int J Womens Health Reprod Sci. 2016; 4 (4): 152–6. DOI: https://doi.org/10.15296/ijwhr.2016.35

21. Annan J.J., Aquilina J., Ball E. The management of endometrial polyps in the 21st century. Obstet Gynaecol. 2012; 14 (1): 33–8. DOI: https://doi.org/10.1111/j.1744-4667.2011.00091.x

22. Taylor L.J., Jackson T.L., Reid J.G. The differential expression of oestrogen receptors, progesterone receptors, Bcl-2 and Ki67 in endometrial polyps. BJOG. 2003; 110 (9): 794–8. DOI: https://doi.org/10.1590/1516-3180.2018.0346.R4.19112019

23. Mourits M.J.E., Hollema H., De Vries E.G. Apoptosis and apoptosis-associated parameters in relation to tamoxifen exposure in postmenopausal endometrium. Hum Pathol. 2002; 33 (3): 341–6. DOI: https://doi.org/10.1053/hupa.2002.32226

24. Altaner S., Gucer F., Tokatli F. Expression of Bcl-2 and Ki-67 in tamoxifen-associated endometrial polyps: comparison with postmenopausal polyps. Onkologie. 2006; 29 (8–9): 376–80. DOI: https://doi.org/10.1159/000094443

25. Antunes A. Jr, Andrade L.A., Pinto G.A., et al. Is the immunohistochemical expression of proliferation (Ki-67) and apoptosis (Bcl-2) markers and cyclooxigenase-2 (COX-2) related to carcinogenesis in postmenopausal endometrial polyps? Anal Quant Cytopathol Histpathol. 2012; 34 (5): 264–72. PMID: 23301386.

26. Hu J., Yuan R. The expression levels of stem cell markers importin13, c-kit, CD146, and telomerase are decreased in endometrial polyps. Med Sci Monit. 2011; 17 (8): BR221–7. DOI: https://doi.org/10.12659/msm.881901

27. Banas T., Pitynski K., Mikos M. Endometrial polyps and benign endometrial hyperplasia have increased prevalence of DNA fragmentation factors 40 and 45 (DFF40 and DFF45). together with the antiapoptotic B-cell lymphoma (Bcl-2) protein compared with normal human endometria. Int J Gynecol Pathol. 2018; 37 (5): 431–40. DOI: https://doi.org/10.1097/PGP.0000000000000442

28. Miranda S.P., Traiman P., Candido E.B. Expression of p53, Ki-67, and CD31 proteins in endometrial polyps of postmenopausal women treated with tamoxifen. Int J Gynecol Cancer. 2010; 20 (9): 1525–30. DOI: https://doi.org/10.1111/IGC.0b013e3181f7b33b

29. Al-Jefout M., Black K., Schulke L. Novel finding of high density of activated mast cells in endometrial polyps. Fertil Steril. 2009; 92 (3): 1104–6. DOI: https://doi.org/10.1016/j.fertnstert.2009.02.016

30. El-Hamarneh T., Hey-Cunningham A.J., Berbic M. Cellular immune environment in endometrial polyps. Fertil Steril. 2013; 100 (5): 1364–72. DOI: https://doi.org/10.1016/j.fertnstert.2013.06.050

31. Norrby K. Mast cells and angiogenesis. APMIS. 2002; 110 (5): 355–71. DOI: https://doi.org/10.1034/j.1600-0463.2002.100501.x

32. Belov A.I., Ponomareva N.A. Risk factors for the development of endometrial polyps in women of different age groups. Molodezh – prakticheskomu zdravookhraneniyu [Youth – Practical Health Care]. 2019: 23–8. eLIBRARY ID: 42461478. (in Russian)

33. Richlin S.S., Ramachandran S., Shanti A., Murphy A.A., Parthasarathy S. Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation. Hum Reprod. 2002; 17 (10): 2742–7. DOI: https://doi.org/10.1093/humrep/17.10.2742

34. Stenchever M.A., Droegemueller W., Herbst A.L., Mishell D.R. Benign gynecologic lesions. In: Comprehensive Gynecology. St Louicis: Mosby, 2001: 495–7. DOI: https://doi.org/10.1016/S0015-0282(01)02972-7

35. Dal Cin P., Vanni R., Marras S. Four cytogenetic subgroups can be identified in endometrial polyps. Cancer Res. 1995; 55 (7): 1565–8. PMID: 7882366.

36. Xuebing P., TinChiu L., Enlan X., Jing L., Xiaowu H. Is endometrial polyp formation associated with increased expression of vascular endothelial growth factor and transforming growth factor-beta1? Eur J Obstet Gynecol Reprod Biol. 2011; 159 (1): 198–203. DOI: https://doi.org/10.1016/j.ejogrb.2011.06.036

37. Stewart C.J., Bharat C., Crook M. p16 immunoreactivity in endometrial stromal cells: stromal p16 expression characterises but is not specific for endometrial polyps. Pathology. 2015; 47 (2): 112–7. DOI: https://doi.org/10.1097/PAT.0000000000000211

38. Takeda T. Mutations of RAS genes in endometrial polyps. Oncol Rep. 2019; 42 (6): 2303–8. DOI: https://doi.org/10.3892/or.2019.7353

39. Wang J., Zhao J., Lin J. Opportunities and risk factors for premalignant and malignant transformation of endometrial polyps: management strategies. J Minim Invasive Gynecol. 2010; 17: 53–8. DOI: https://doi.org/10.1016/j.jmig.2009.10.

40. Ferrazzi E., Zupi E., Leone F.P., Savelli L., Omodei U., Moscarini M., et al. How often are endometrial polyps malignant in asymptomatic postmenopausal women? A multicenter study. Am J Obstet Gynecol. 2009; 200: 235.e1–6. DOI: https://doi.org/10.1016/j.ajog.2008.09.876

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITORS
CHIEF EDITOR
Sukhikh Gennadii Tikhonovich
Academician of the Russian Academy of Medical Sciences, V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Moscow
CHIEF EDITOR
Kurtser Mark Arkadievich
Academician of the Russian Academy of Sciences, MD, Professor, Head of the Obstetrics and Gynecology Subdepartment of the Pediatric Department, N.I. Pirogov Russian National Scientific Research Medical University, Ministry of Health of the Russian Federation
CHIEF EDITOR
Radzinsky Viktor Evseevich
Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of the Subdepartment of Obstetrics and Gynecology with a Course of Perinatology of the Medical Department in the Russian People?s Friendship University

Journals of «GEOTAR-Media»