Predictors of endometrial polyp recurrence and potential preventive methods

Introduction. Endometrial polyposis is a common gynecological disease, resulting in benign overgrowths of endometrial tissue and being associated with abnormal uterine bleeding, infertility, and recurrent implantation failure. The recurrence rate following polypectomy varies from 14.2 to 45.5 %, leading to repeated intrauterine interventions and posing a significant obstacle to pregnancy achievement. Further research is needed to identify predictors of endometrial polyp recurrence and potential preventive strategies. Aim : to study and analyze scientific data on endometrial polyps related to underlying pathogenesis, diagnosis, and prevention methods. Materials and Methods. The literature search was conducted in the electronic databases eLibrary.ru, CyberLeninka, PubMed/ MEDLINE for the period 2015–2025 using keywords and phrases in Russian and English: «endometrial polyps», «pathogenesis», «endometrial polyps recurrence», «polypectomy», «chronic endometritis». Publications reporting original research findings were selected for analysis. The scientific data analysis included various inflammatory markers, their role in predicting endometrial polyp recurrence, and potential preventive measures. Results. The current scientific concept considers endometrial polyps and chronic endometritis (CE) as stages of a single pathological process resulting from chronic inflammation as evidenced by similarities in dysregulated pathogenetic pathways and the uterine microbiome therein. It has been found that the majority of infertile patients with endometrial polyps show CE signs (51–92.6 %). CE markedly increases a risk of endometrial polyp recurrence post-resection. In addition, a risk of endometrial polyp recurrence correlates with CE severity. However, in most cases, hysteroscopic polypectomy alone was sufficient to treat CE with endometrial polyps without antibiotic therapy. Moreover, inappropriate antibiotic therapy may not only be ineffective but also delay recovery from CE, reduce the efficacy of CE-related polypectomy and increase the frequency of endometrial polyp recurrence. This suggests a need to identify predictors of endometrial polyp recurrence to determine risk groups and optimize management strategies for such patients. Analyzing scientific publications revealed significant differences in the levels of CD138 (plasma cell marker), CD20 (B-cell lymphocyte marker), CD8 (cytotoxic T-cell lymphocyte marker), matrix metalloproteinases, cyclooxygenase 2, and proteins of the Hippo-YAP1 and Wnt signaling pathways in endometrial polyp tissue compared to normal endometrium. Additionally, a decreased and altered uterine microbiota diversity were observed, which may be promising to seek out for markers predicting endometrial polyp recurrence. Conclusion. The high prevalence and recurrence of endometrial polyps related to chronic endometritis, along with shared pathogenetic mechanisms, suggests that factors associated with CE could may serve as potential predictors of endometrial polyp recurrence. Comprehensively investigated uterine microbiome and factors contributing to endometrial polyp development build up a relevant and promising strategy promoting uncovering related to development of this pathology, optimizing management for patients with endometrial polyp recurrence as well as proposing pathogenesis-driven preventive and therapeutic approaches.