Comprehensive Analysis of Risk Factors for Recurrence in Women of Reproductive Age Undergoing Hysteroscopic Polypectomy

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Abstract
BACKGROUND Endometrial polyps are a common gynecological condition that often cause significant clinical symptoms. Hysteroscopic resection is considered the gold standard treatment; however, recurrence remains a notable risk even after surgery. The recurrence of endometrial polyps after surgery raises concerns for women, due to persistent symptoms and potential malignancy risk. Therefore, this study aims to identify factors influencing recurrence in reproductive-aged women undergoing hysteroscopic polyp resection. MATERIAL AND METHODS We conducted a retrospective analysis of 1021 reproductive-aged women who underwent hysteroscopic polypectomy for abnormal uterine bleeding between 2010 and 2024. Diagnoses were confirmed by histopathological examination. Multivariable logistic regression modeling was used to determine predictors of recurrence. RESULTS Endometrial polyp recurrence occurred in 8% of patients, with a median recurrence time of 42.5 months. Levonorgestrel-releasing intrauterine system (LNG-IUS) treatment significantly reduced recurrence (odds ratio [OR]=0.043, 95% CI=0.019-0.097, P<0.001). Risk factors for recurrence included adenomyosis (OR=10.297, 95% CI=5.251-20.188, P<0.001), polycystic ovarian syndrome (OR=8.990, 95% CI=2.855-28.312, P<0.001), body mass index ≥30 kg/m² (OR=8.698, 95% CI=4.521-16.736, P<0.001), tamoxifen use (OR=6.088, 95% CI: 1.936-19.140, P=0.002), and leiomyoma uteri (OR=4.012, 95% CI: 2.143-7.509, P<0.001). CONCLUSIONS Clinicians should inform patients at high risk, including those with adenomyosis, myoma uteri, polycystic ovarian syndrome, or tamoxifen use, about the increased risk of recurrence and should conduct regular follow-ups. LNG-IUS treatment can be considered for the prevention of recurrence and enhancement of management strategies.

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