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Clinical characteristics of postmenopausal women with endometrial polyps

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.307

Abstract

Introduction. The issues of rise in incidence and malignant transformation of endometrial pathology along with elevating proportion of postmenopausal women in global population remain relevant.

Aim: to evaluate clinical and laboratory data of postmenopausal patients with endometrial polyp.

Materials and Methods. There were enrolled 156 cases of morphologically verified endometrial polyp; the age of the study patients averaged 61.39 ± 7.78 years. Clinical and laboratory data of the obstetric and gynecological history were analyzed; the somatic history was assessed (cardiovascular diseases, arterial hypertension, coronary heart disease). Analysis of laboratory data was performed: complete blood count (CBC), general urinalysis, biochemical parameters – level of cholesterol (Cholesterol), low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glucose, alanine aminotransferase (ALAT), asparagine aminotransferase (ASAT), tumor marker CA-125. Statistical processing of the results was carried out.

Results. Endometrial polyps were found by 17% more frequently in patients with late postmenopausal age, which were more (95.5%) prevalent in subjects without history of impaired fertility. Moreover, they also had a high rate (84.6%) of medical abortions and use of intrauterine contraceptives (every second patient). In the vast majority of cases (1/3), the patients had a history of inflammatory diseases of the uterus and uterine appendages, whereas before surgery they had in 37.2% vaginal inflammation requiring sanitation. According to the clinical course, the endometrial polyp manifested equally in early and late post-menopause, with a predominance of spotting (27.5%) and complaints of pain (24.4%). A high frequency of relapses after polypectomy was revealed so that every third patient had already undergone relevant surgery. A high incidence of arterial hypertension (71.6%), fat metabolism disorders (82.1%) were revealed in both early and late postmenopausal patients, while fat metabolism disorders were associated with the symptomatic course of endometrial polyps.

Conclusion. The study results showed a statistically significant relationship between the endometrial polyp formation in postmenopausal patients and detected inflammatory pathology of the pelvic organs, diseases of the cardiovascular system and fat metabolism disorders. Further studies are necessary to verify importance of the identified factors as clinical prognostic factors.

About the Authors

E. G. Kobaidze
Wagner Perm State Medical University, Health Ministry of Russian Federation
Russian Federation

Ekaterina G. Kobaidze – MD, Dr Sci Med, Professor, Department of Obstetrics and Gynecology № 1

26 Petropavlovskaya Str., Perm 614990

Scopus Author ID: 57219650638



Y. N. Matveeva
Wagner Perm State Medical University, Health Ministry of Russian Federation; Perm Krai «Kungur Hospital»
Russian Federation

Yuliya N. Matveeva – MD, Applicant, Department of Obstetrics and Gynecology № 1; Obstetrician-Gynecologist, Perm Krai «Kungur Hospital»

26 Petropavlovskaya Str., Perm 614990,
45 bldg. В
, Krasnogvardeitsev Str., Kungur 617472



E. V. Shirinkina
Wagner Perm State Medical University, Health Ministry of Russian Federation
Russian Federation

Elena V. Shirinkina – MD, PhD, Associate Professor, Department of Obstetrics and Gynecology № 1

26 Petropavlovskaya Str., Perm 614990

Author ID: 481756



N. V. Statnykh
Wagner Perm State Medical University, Health Ministry of Russian Federation
Russian Federation

Natalya V. Statnykh – MD, PhD, Associate Professor, Department of Obstetrics and Gynecology № 1

26 Petropavlovskaya Str., Perm 614990

Author ID: 780493



N. M. Pirozhnikova
Wagner Perm State Medical University, Health Ministry of Russian Federation
Russian Federation

Natalija M. Pirozhnikova – MD, PhD, Associate Professor, Department of Obstetrics and Gynecology № 1

26 Petropavlovskaya Str., Perm 614990



References

1. Kobaidze E.G., Matveeva Yu.N. Comparison of ultrasound scanning and morphological data in patients with postmenopausal endometrial polyps. [Sravnenie dannyh ul'trazvukovogo skanirovaniya i morfologicheskogo issledovaniya polipov endometriya u bol'nyh v postmenopauze]. Permskij medicinskij zhurnal. 2021;38(2):70–8. (In Russ.). https://doi.org/10.17816/pmj38270-78.

2. Anastasiadis P.G., Koutlaki N.G., Skaphida P.G. et al. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol. 2000;21(2):180–3.

3. 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(1):102–8. https://doi.org/10.1002/uog.6259.

4. Haimov-Kochman R., Deri-Hasid R., Hamani Y., Voss E. The natural course of endometrial polyps: could they vanish when left untreated? Fertil Steril. 2009;92(2):828.e11–2. https://doi.org/10.1016/j.fertnstert.2009.04.054.

5. Wethington S.L., Herzog T.J., Burke W.M. et al. Risk and predictors of malignancy in women with endometrial polyps. Ann Surg Oncol. 2011;18(13):3819–23. https://doi.org/10.1245/s10434-011-1815-z.

6. Schlesinger C., Kamoi S., Ascher S.M. et al. Endometrial polyps: acomparison study of patients receiving tamoxifen with two control groups. Int J Gynecol Pathol. 1998;17(4):302–11.

7. Ramondetta L.M., Sherwood J.B., Dunton J.D., Palazzo J.P. Endometrial cancer in polyps associated with tamoxifen use. Am J Obstet Gynecol. 1999;180(2 Pt 1):340–1. https://doi.org/10.1016/S0002-9378(99)70210-3.

8. Cohen I., Perel E., Flex D. et al. Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients. J Clin Pathol. 1999;52(4):278–82. https://doi.org/10.1136/jcp.52.4.278.

9. Golan A., Sagiv R., Berar M. et al. Bipolar electrical energy in physiologic solution—a revolution in operative hysteroscopy. J Am Assoc Gynecol Laparosc. 2001;8(2):252–8. https://doi.org/10.1016/s1074-3804(05)60586-5.

10. Salim S., Won H., Nesbitt-Hawes E. et al. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 2011;18(5):569–81. https://doi.org/10.1016/j.jmig.2011.05.018.

11. Dias D.S., Bueloni-Dias F.N., Dias R. et al. Usefulness of clinical, ultrasonographic, hysteroscopic, and immunohistochemical parameters in differentiating endometrial polyps from endometrial cancer. J Minim Invasive Gynecol. 2014;21(2):296–302. https://doi.org/10.1016/j.jmig.2013.09.015.

12. Cohen I. Endometrial pathologies associated with postmenopausal tamoxifen treatment. Gynecol Oncol. 2004;94(2):256–66. https://doi.org/10.1016/j.ygyno.2004.03.048.

13. Nappi L., Indraccolo U., Di SpiezioSardo A. et al. Are diabetes, hypertension, and obesity independent risk factors for endometrial polyps? J Minim Invasive Gynecol. 2009;16(2):157–62. https://doi.org/10.1016/j.jmig.2008.11.004.

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

15. Dibi R.P., Zettler C.G., Vanin C.M.M. et al. Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study. Sao Paulo Med J. 2020;138(1):64–8. https://doi.org/10.1590/1516-3180.2018.0346.R4.19112019.

16. Taylor L.J., Jackson T.L., Reid J.G., Duffy S.R. The differential expression of oestrogen receptors, progesterone receptors, Bcl-2 and Ki67 in endometrial polyps. BJOG. 2003;110(9):794–8. https://doi.org/10.1111/j.1471-0528.2003.02098.x.

17. Biron-Shental T., Tepper R., Fishman A. et al. Recurrent endometrial polyps in postmenopausal breast cancer patients on tamoxifen. Gynecol Oncol. 2003;90(2):382–6. https://doi.org/10.1016/S0090-8258(03)00276-2.

18. Sant’Ana de Almeida E.C., Nogueira A.A., Candido dos Reis F.J. et al. Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps and adjacent endometrium in postmenopausal women. Maturitas. 2004;49(3):229–33. https://doi.org/10.1016/j.maturitas.2004.02.009.

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

20. Koshiyama M., Yoshida M., Takemura M. et al. Immunohistochemical analysis of distribution of estrogen receptors and progesterone receptors in the postmenopausal endometrium. Acta Obstet Gynecol Scand. 1996;75(8):702–6. https://doi.org/10.3109/00016349609065730.

21. Maia H., Maltez A., Calmon L.C. et al. Histopathology and steroid receptors in endometrial polyps of postmenopausal patients under hormonereplacement therapy. Gynaecological Endoscopy. 1998;7(5):267–72. https://doi.org/10.1046/j.1365-2508.1998.00198.x.

22. Thijs I., Neven P., Van Hooff I. et al. Oestrogen and progesterone receptor expression in postmenopausal endometrial polyps and their surrounding endometrium. Eur J Cancer. 2000;36(4):108–9. https://doi.org/10.1016/S0959-8049(00)00263-X.

23. Bergeron C. Effect of estrogens and antiestrogens on the endometrium. Gynecol Obstet Fertil. 2002;30(12):933–7. [Article in French]. https://doi.org/10.1016/S1297-9589(02)00486-1.

24. Belisario M.S., Vassallo J., Andrade L.A. et al. The expression of the hormone receptors in the endometrium and endometrial polyps in postmenopausal women and its relationship to body mass index. Maturitas. 2006;53(1):114–8. https://doi.org/10.1016/j.maturitas.2005.03.013.

25. de Carvalho S., Campaner A.B., Lima S.M. et al. Differential expression of estrogen and progesterone receptors in endometrial polyps and adjacent endometrium in postmenopausal women. Anal Quant Cytol Histol. 2011;33(2):61–7.

26. Morsi H.M., Leers M.P., Jager W. et al. The patterns of expression of an apoptosis-related CK18 neoepitope, the bcl-2 protooncogene, and the Ki-67 proliferation marker in normal, hyperplasic and malignant endometrium. Int J Gynecol Pathol. 2000;19(2):118–26. https://doi.org/10.1097/00004347-200004000-00004.

27. Risberg B., Karlsson K., Abeler V. et al. Dissociated expression of Bcl-2 and Ki-67 in endometrial lesions: diagnostic and hystogenetic implications. Int J Gynecol Pathol. 2002;21(2):155–60. https://doi.org/10.1097/00004347-200204000-00008.

28. McGurgan P., Taylor L.J., Duffy S.R., O’Donovan P.J. 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. https://doi.org/10.1016/j.maturitas.2005.11.007.

29. Kobaidze E.G., Matveeva Yu.N., Padrul M.M. Pathology of endometrium of patients in postmenopausal age. [Patologiya endometriya u pacientok postmenopauzal'nogo vozrasta]. Ural'skij medicinskij zhurnal. 2020;(5):116–21. (In Russ.). https://doi.org/10.25694/URMJ.2020.05.25.

30. Kacalska-Janssen O., Rajtar-Ciosek A., Zmaczynski A. et al. Markers of insulin resistance in perimenopausal women with endometrial pathology. Ginekol Pol. 2013;84(11):922–9. https://doi.org/10.17772/gp/1661.


Review

For citations:


Kobaidze E.G., Matveeva Y.N., Shirinkina E.V., Statnykh N.V., Pirozhnikova N.M. Clinical characteristics of postmenopausal women with endometrial polyps. Obstetrics, Gynecology and Reproduction. 2022;16(3):255-265. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2022.307

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