Identification of predictors of endometrial pathology recurrence in patients after polypectomy

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Abstract

BACKGROUND: Endometrial polyps are a benign intrauterine condition whose etiology remains unclear. Altered uterine microbiota is one possible contributing factor. Furthermore, recurrence rates after polypectomy remain high, making postoperative management to reduce recurrence a relevant issue.

AIM: To identify predictors of endometrial pathology recurrence in patients after polypectomy.

METHODS: The study included 147 reproductive-age patients with endometrial polyps who underwent polypectomy. Postoperative hormonal therapy was given to 123 (83.7%) patients, while 24 (16.3%) declined it. We analyzed the association between recurrence and the recommended treatment, and between recurrence and vaginal microflora characteristics.

RESULTS: No patient who received a levonorgestrel-releasing intrauterine system (LNG-IUS) required repeat surgery. Combined oral contraceptive (COC) use reduced the likelihood of hysteroscopy with diagnostic curettage 2.6-fold compared with patients who declined treatment, and cyclic progestogen use reduced it 1.9-fold compared with the observation-only group. Bacterial vaginosis was associated with a 3.4-fold higher reoperation rate than other vaginal microflora states.

CONCLUSION: After polypectomy, to prevent abnormal uterine bleeding, LNG-IUS placement or COC use should be considered for women who need contraception. In addition, timely detection of vaginal dysbiosis during follow-up is important, as it affects the incidence of endometrial proliferative disease.

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About the authors

Aznar S. Khachatryan

Yerevan State Medical University after Mkhitar Heratsi

Email: aznardoc@yahoo.com
ORCID iD: 0009-0000-2767-8995
SPIN-code: 7707-5981

MD, Cand. Sci. (Medicine), Associate Professor

Armenia, Yerevan

Yulia E. Dobrokhotova

Russian National Research Medical University n.a. N.I. Pirogov

Email: pr.dobrohotova@mail.ru
ORCID iD: 0000-0002-7830-2290
SPIN-code: 2925-9948

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Irina Yu. Ilyina

Russian National Research Medical University n.a. N.I. Pirogov; Yaroslavl State Medical University

Author for correspondence.
Email: iliyina@mail.ru
ORCID iD: 0000-0001-8155-8775
SPIN-code: 5753-4380

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow; Yaroslavl

Metanat R. Narimanova

Russian National Research Medical University n.a. N.I. Pirogov

Email: safarovametanat@yandex.ru
ORCID iD: 0000-0003-0677-2952
SPIN-code: 2723-5711

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. The state of the vaginal microbiota in patients with various comorbidities: BV — bacterial vaginosis; TG — thyroid gland; SD — diabetes mellitus; GI — gastrointestinal tract; BLS — bronchopulmonary system; US — urinary system.

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3. Fig. 2. Frequency of repeat surgery depending on the recommended treatment in the postoperative period: COCs – combined oral contraceptives; LNG-IUS – levonorgestrel-releasing intrauterine system.

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4. Fig. 3. Frequency of repeat surgical treatment depending on the results of microbiological examination: BV - bacterial vaginosis; HS and RDV - hysteroscopy and separate diagnostic curettage.

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5. Fig. 4. Changes in vaginal microbiota depending on the patient management tactics in the postoperative period: BV – bacterial vaginosis; COC – combined oral contraceptives; LNG-IUS – levonorgestrel-releasing intrauterine system.

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6. Fig. 5. ROC curve characterizing the dependence of the probability of repeat surgical intervention on the value of the logistic function p.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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