The Assessment of the Relationship Between Endometrial Polyps and Basal Serum Estradiol Levels in Infertility Patients (original) (raw)
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The role of hormone replacement therapy in endometrial polyp formation
Maturitas, 2005
Objective: To evaluate the iatrogenic effect of different protocols of hormone replacement therapy (HRT) on endometrial polyp formation adjusting for the confounding effects of other factors such as age, parity, weight and menopausal status at menopause. Methods: Out of 2685 menopause patients 375 (13.9%) eligible patients were enrolled. Patients were randomized to three HRT types and three equal groups were formed. The first group received Premelle 2.5 mg (Group-I) (0.625 mg conjugated estrogen + 2.5 mg medroxyprogestorone), the second received Kliogest (Group-II) (2 mg estradiol + 1 mg norethisterone) and the last received Livial (Group-III) (2.5 mg tibolone) at least for 36 months without giving a break. After the first 18 months patients had their first office hysteroscopy and it was repeated in every 6 months until the end of third year to find out new and recurrent endometrial polyps. Results: Multiple regression analysis revealed that the type of HRT, late menopause and obesity increased the occurrence of endometrial polyps. In Group-I five polyps, in Group-II ten polyps and in Group-III two polyps were detected. There were significant differences between G-II and G-I and G-II and G-III (P < 0.05), but there was no significant difference between G-I and G-III (P > 0.05). 82.3% of the polyps were detected in the third and fourth hysteroscopic examinations. Endometrial polyp recurrence was encountered in 4 (23.5%) patients, 1 in G-I and 3 in G-II without a significant difference (P > 0.05). No malignancy was detected in any of the specimen. Conclusion: We observed that endometrial polyp formation may be dependent on the type and dosage of the estrogen and progestogen. Especially a progestogen with high antiestrogenic activity may play an important preventive role in the development of endometrial polyps.
Endometrial polyps during menopause: characterization and significance
Acta Obstetricia et Gynecologica Scandinavica, 2000
Background. To characterize postmenopausal women with endometrial polyps and to evaluate their significance. Methods. The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings. Results. Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p∞0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories. Conclusions. Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.
Archives of Gynecology and Obstetrics, 2010
Objective To investigate the diVerences in steroid receptor expression patterns between glandular and stromal portions in endometrial polyps among premenopausal and postmenopausal patients and the relationship between the receptor expression in endometrial polyps and clinical parameters. Materials and methods A total of 25 postmenopausal and 25 premenopausal patients with solitary endometrial polyp detected by oYce hysteroscopy were involved in the study. All patients underwent hysteroscopic polypectomy under general anesthesia or spinal anesthesia. Estrogen and progesterone expression patterns were investigated in the polyps using immunohistochemistry. The mean age was 57.6 years in postmenopausal patients and 36.9 in premenopausal patients. Average gravida, body mass index (BMI), and frequency of smokers did not diVer between groups. However, the patient's age and their concomitant diseases were signiWcantly diVerent between premenopausal and postmenopausal patients (P = 0.01). Results Comparison in postmenopausal patients showed that glandular estrogen and progesterone receptor expression were both signiWcantly greater than stromal estrogen and progesterone receptor expression (P = 0.037 and <0.001, respectively). Proliferative phase endometrial polyps also demonstrated signiWcantly greater expression of progesterone receptors in glandular epithelium compared with stroma (P = 0.019). However, stromal and glandular estrogen receptor expression did not diVer among premenopausal patients. There was a statistically signiWcant correlation among stromal progesterone receptor expression, plasma estrogen and FSH level (P = 0.01). A negative correlation was found between stromal progesterone receptor expression and patient's age (P = 0. 01). Conclusion Estrogen and progesterone receptor expression were lower in the stromal portion of the endometrial polyp than in the glandular portion in postmenopausal patients. Stromal progesterone receptor expression was lower in older patients and there was a relation between low estrogen hormone levels and lower stromal progesterone receptor expression.
2014
OBJECTIVE: To compare clinical and laboratory parameters in middle and advanced reproductive age women with endometrial polyps. STUDY DESIGN: We designed a retrospective study among reproductive age women who were managed at our clinic with the diagnosis of endometrial polyps. Thirty seven women older than 40 years of age (study group), and 113 women younger than 40 years (control group) were compared in terms of various clinical and laboratory parameters including age, body mass index (BMI), gravidity, parity, abortion, basal hormone levels, tumor markers, complete blood count values, smoking status, presence of polycystic ovary syndrome (PCOS), infertility status, co-morbidities, and number and size of endometrial polyps. RESULTS: The mean age of patients in the study and control groups were 45.2±3.5 and 30.6±4.9 years, respectively (p<0.001). The median BMI, gravidity, parity and abortion were significantly higher in study group (p<0.05). Infertility was more common in control group (65.5% vs. 10.8%; p<0.001). Fasting plasma glucose, basal FSH (follicle stimulating hormone) and estradiol (E2) levels were higher in study group than control group (p<0.05). Mean tumor marker levels were similar in both groups. Complete blood count values, smoking status, presence of PCOS, and number and size of polyps did not differ significantly between the two groups. The most common location of endometrial polyps within the uterine cavity was the posterior wall. There was no correlation between number and size of polyps and basal hormone levels (p>0.05). CONCLUSION: According to this study, 40 years of age and older women with endometrial polyps were more obese and had higher basal FSH and E2 levels. Obesity and increased estrogen levels may be contributing risk factors for developing endometrial polyps in women over 40 years of age.
Molecular and clinical oncology, 2013
Postmenopausal women who use tamoxifen present with an increased incidence of endometrial alterations, such as polyps and hyperplasia, in addition to a higher risk of malignant endometrial neoplasms. Among these endometrial changes, polyps are the most common, with a pathogenesis associated with hormonal influence. The objective of this study was to compare the expression of estrogen receptors (ERs) and progesterone receptors (PRs) in endometrial polyps from tamoxifen users with that in endometrial polyps and the atrophic endometrium of postmenopausal tamoxifen non-users. Among women undergoing surgical hysteroscopy, 84 tamoxifen users with benign endometrial polyps were selected. This group was compared to 84 samples of atrophic endometrium and to 252 benign polyps from postmenopausal women who were not treated with tamoxifen. The expression of ER/PR was assessed by immunohistochemical analysis, according to the percentage of stained cells, intensity of nuclear staining and final s...
Endometrial polyps in infertility patients: The first study of their clinical characteristics
Clinical and experimental obstetrics & gynecology, 2018
Purpose: The study aim was to investigate clinical characteristics of endometrial polyps in women with and without infertility. Materials and Methods: Study included all patients of reproductive age who had a hysteroscopy due to endometrial polyps during 30 months. Patients were divided according to infertility problems. Detailed medical history was taken from all patients (age, BMI, parity, comorbidities, symptoms/signs, and polyp recurrence). On ultrasound scan, the polyp's largest diameter and endometrial thickness were assessed. During hysteroscopy localization of polyps and other intrauterine formations were registered. Removed polyps were histopathologically analyzed (size and histological type). Results: Study involved 257 patients (average 38.5 years of age), out of which 79 had infertility problem, while 178 patients constituted the control group. There were no significant differences regarding patient's BMI, age in decades, number of abortions, presence of comorbidities, taking hormone therapy, symptoms/signs, localization or diameters of polyps, polyp recurrence, other intrauterine findings, and histopathological types of polyps between women with and without infertility problems. Conclusion: Clinical characteristics of endometrial polyps are quite similar in women with and without infertility problems.
Oncology Letters, 2014
The aim of the present study was to evaluate estrogen receptor (ER) and progesterone receptor (PR) expression in the glandular epithelium and stroma of benign and malignant endometrial polyps of postmenopausal patients. A total of 1,050 females underwent surgical hysteroscopy at the Professor Dr José Aristodemo Pinotti Women's Hospital, Center for Integral Attention to Women's Health of the State University of Campinas, between January 1998 and December 2008. Of the total number, 390 postmenopausal females with endometrial polyps were included in the study. Polypoid lesions were histologically classified as benign lesions (endometrial polyps and polyps with non-atypical simple hyperplasia or non-atypical complex hyperplasia) and premalignant and malignant lesions (polyps with atypical simple hyperplasia or atypical complex hyperplasia and carcinomatous polyps). ER and PR expression was evaluated by immunohistochemistry according to cell staining, intensity of nuclear staining and final score. The final score for receptor expression was compared between the benign and premalignant/malignant polyps. The prevalence of malignancy in endometrial polyps was 7.1% and was associated with postmenopausal bleeding. Only the final score for ER expression in the stroma of endometrial polyps was higher in the benign group than in the premalignant/malignant group, and this difference was significant. However, no difference was identified in PR expression. In addition, the risk of malignancy in endometrial polyps was significantly higher when the expression of ER and PR was negative in the stromal component of the polyp (P<0.01). The malignancy of endometrial polyps was also associated with a low expression of stromal ER, however, PR expression did not show any association with the risk of malignancy.
Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases
European journal of obstetrics, gynecology, and reproductive biology, 2014
To assess the prevalence of polyps carrying a malignancy and match association between clinical factors and oncologic progression. A retrospective study (Canadian Task Force classification II-3) at a university hospital in Rome, Italy. We retrospectively analyzed data from 1027 women consecutively treated for endometrial polyps at our center in the period 2002-2011. The association of malignancy with hormonal status, tamoxifen, hypertension, symptoms, diabetes mellitus, obesity, and hormonal replacement therapy in pre- and post-menopausal women was assessed. Mean age was 45.8±10.8 years. Benign polyps accounted for 95.8% of the total, pre-malignant for 2.67%, malignant for 1.54%. Our data showed that post-menopausal and older women (>60y) with endometrial polyps have a higher risk of developing a related endometrial cancer (OR: 3.05, 95% CI [1.54, 6.19], p<0.001 and OR: 2.8, 95% CI [1.38, 5.56], p≤0.003. Also we observed that women with AUB in the post-menopausal period displa...