Risk Factors Associated with the Malignant Changes of Symptomatic and Asymptomatic Endometrial Polyps in Premenopausal Women

This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy.

One hundred and fifty women aged 29–52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome.

Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p < 0.001; OR 4.61; CI 1.9–27), polyp volume >10 ml (p < 0.001; OR 5.83; CI 4.31–9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09–3.76). Notably, the odds ratio of polyp volume >10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women.

Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume ≤10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.