Factors Associated With Pathogenesis Of Endometrial Polyps

Background:Endometrial polyp (EP) is one of the most common endometrial pathology of women, which could lead to irregular uterine bleeding and infertility. The pathologic change of EP is focal overgrowth of endometrial glands and stroma with thick-walled vessels that protrude into the uterine cavity. Endometrial polyps can occur in any age group of women. In recent years, with the widespread use of hysteroscopy, more EP cases were confirmed. It is reported that the EP incidence among women is about25%, and the incidence in postmenopausal women is up to31%. The peak age of incidence is50years old.The etiology and pathogenesis of EP have been debated for decades. Researches suggested that the pathogenesis of EP mainly involved in mechanisms such as hormone affect, inflammatory stimuli, apoptosis processes, and gene mutations. A variety of factors are reported as risk factors of EP, most of which are inconclusive. Studies showed that factors such as ageing, bcl-2protein, excess weight/obesity, unbalanced estrogen therapy and estrogen-like effect may have a causative link with EP, while progestinics and antiestrogenic action may be protective factors. Besides, menopause, ki-67protein, tamoxifen for a short time, tamoxifen for a long time, hormone replacement therapy (HRT), and endometritis/inflammation have an unclear link with EP. Therefore, the risk factors of EP and the mechanisms should be further confirmed in a study with a large sample.Objective:To identify factors associated with pathogenesis of endometrial polyps(EP).Methods:Case-control study of121women with EP and111controls. The clinical data were recorded and analyzed by univariable logistic analysis and unconditional logistic regression On the software of SPSS.Results:1. The mean age of study group is44±12y.18cases (14.88%) are less than30years old;26cases (21.49%) are between30to39;35cases (28.93%) are between40to49;24cases (19.83%) are in the50-59group,16cases (13.22%) are between60to69years old; and only2cases (1.65%) are older than70.56cases (46.39%) are multiple endometrial polyps. Average diameter of polyps is1.08±0.50cm.2. The typical features of EP in TVS (Trans vaginal Ultrasound):single or multiple hyper echoic foci in endometrium, which are ligulate or oval. The flow signals could be obviously detected on color doppler flow imaging (CDFI). Pathological features of EP:fibrotic stroma, irregular endometrial glands, and thick-walled blood vessels. EP in hysteroscopy is performed as single or multiple finger-like excrescences, which are soft and pink, with or without a pedicle.3. Univariable logistic analysis showed a statistically significant association with age, late menarche, menopausal status, gravidity, parity, endometriosis, cervical polyps and chronic hypertension (all P<0.05). However, only two risk factors, age and gravidity were finally filtered out by multivariable Conditional Logistic Regression (P<0.05), with their OR values being1.163and0.407, respectively.Conclusion:Aging may be a risk factor of EP, while gravidity may be a protective factor.