Risk Factors Of Endometrial Polyps And Malignance In Postmenopausal Women

BackgroundEndometrial polyps (EP) results from local hyperplasia of glands and stroma in the endometrium. EP is a kind of popular gynecological disease, EP develops in any periods of age but most commonly in40-49years old. It is characterized of menorrhagia, irregular bleeding and post-menopausal bleeding, however, almost41%of EP is asymptomatic and diagnosed by imaging methods. Ultrasonography is of great importance, and hysteroscopy is the gold standard of the diagnosis and treatment for EP. With the development of ultrasound and hysteroscopy techniques, the morbility of EP is arising, the incidence is25%in population, while in women over30years old10%of EP were asymptomatic. Although majority of EP are benign lesions, some EPs might become malignant, especially in postmenopausal period, the rate of malignant transformation is as high as10%. With the improved health view, more postmenopausal EPs were found, which attract more attention in prevention and treatment. However, the pathogenesis of EP is not well understood up to now, and there were little hints in the risk factors and causes of malignant transformation in postmenopausal EPs. ObjectiveTo investigate the risk factors of pathogenesis and malignant transformation of endometrial polyps in postmenopausal women, in order to provide some evidences for clinical prevention and treatment of EP.MethodsSelect the postmenopausal women who had hysteroscopy for EP diagnosed by ultrasound, from June2012to December2014in the Women’s Hospital School of Medicine Zhejiang University, the patients were divided into normal endometrium group (control group), EP group and malignant EP group according to the pathology. Record clinical data including:clinical symptoms, signs, ultrasound image, age, menopausal age, menopause year, body mass index(BMI), gravidity, parity, history of IUD placement, uterine operating history, cervical polyp, chronic endometritis, hormone-related gynecological diseases (uterine myoma, pelvic endometriosis), hormone replacement therapy, and the history of endometrial cancer risk factors (obesity, hypertension, diabetes). Univariate and multivariate unconditional Logistic Regression Analysis were used for statistical analysis by SPSS.Results1、There were92cases in the control group, average age was54.86±6.25years old, menopausal age was48.36±5.17years old, menopausal year was8.31±3.49years; EP group was149cases, average age was53.47±7.08years old, menopausal age was49.10±7.26years old, menopausal year was6.59±4.49years; malignant EP group was17cases, average age was53.94±8.65years old, menopausal age was47.53±5.93years old, menopausal year was7.37±3.52years. There were no significant differences in age, menopausal age and menopause years in these three groups (p>0.05).2、The average BMI was21.06±5.29and obesity accounted for22.83%in control group; the average BMI was23.36±4.72and obesity accounted for31.54%in EP group; the average BMI was24.68±5.62while obesity accounted for47.05%in malignant EP group. There were significant statistic differences among the three groups in BMI and obesity, and the severity of BMI and obesity in sequence was malignant EP group, EP group and control group (p<0.05).3、According to the symptoms of EP, asymptomatic, postmenopausal uterine bleeding, vaginal discharge and lower abdominal pain accounted for46.74%,31.52%,11.96%and9.78%in control group respectively; such symptoms accounted for47.65%,30.20%,13.42%and8.73%in EP group respectively; while in malignant EP group these symptoms accounted for23.54%,58.82%,11.76%and5.88%respectively. Postmenopausal uterine bleeding in malignant EP group was significantly higher than the EP group and the control group (p<0.05); there was no significant difference between the control group and the EP group (p>0.05).4、Univariate statistical analysis revealed that the following might be the risk factors of EP in postmenopausal patients:cervical polyps, chronic endometritis, complicated with hormonal gynecological diseases, hormone replacement therapy, hypertension and obesity (p<0.05). According to logistic regression statistical analysis, cervical polyps, chronic endometritis, hormone replacement therapy and obesity have strong relationship with EP in post menopause (p<0.05), and OR values were2.73,1.87,3.69and2.59respectively. 5、Univariate statistical analysis revealed that the following factors were related with the malignant transformation of EP in postmenopausal patients:hormone replacement therapy, postmenopausal uterine bleeding, high blood pressure and obesity (p<0.05), while postmenopausal uterine bleeding and obesity had strong relationship with malignant EP, the OR values were2.19,3.06respectively according to logistic regression in statistic.ConclusionCervical polyp, chronic endometritis, hormone replacement therapy and obesity are the risk factors of postmenopausal EP. Postmenopausal uterine bleeding and obesity are the risk factors of malignant transformation of EP in postmenopausal period.