Predictors of Endometrial Polyp Formation in Asymptomatic Postmenopausal Patients

One-third of asymptomatic, postmenopausal women who underwent hysterectomy for uterovaginal prolapse have endometrial polyps, according to a study published in the February 2025 issue of The American Journal of Obstetrics & Gynecology.1 Those using menopausal hormone therapy and women with a higher body mass index (BMI) were particularly at risk for developing these polyps. 

This study aimed to determine the prevalence of endometrial polyps in postmenopausal women without symptoms of bleeding and to identify risk factors linked to their occurrence. The study, with a cross-sectional design, examined the prevalence of endometrial polyps in 317 asymptomatic, postmenopausal women who underwent hysterectomy for uterovaginal prolapse. Women who had a hysterectomy for other indications, including postmenopausal bleeding, were not included in the study. Eligible patients received care at a single medical facility in Washington state between 2009 and 2018. The primary outcome was the identification of endometrial polyps through pathology. Risk factors for the presence of polyps were analysed using both univariate analysis and multivariate regression. 

Out of the 317 women included in the study, 106 (33.4%) had endometrial polyps. The average size of the polyps was 13mm, and the average endometrial thickness was 1.4 mm. The majority (78%) of cases had a single polyp. Two participants (1.89%) were found to have premalignant and malignant lesions; one had endometrial intraepithelial neoplasia and the second had endometrial carcinoma. Baseline clinical and demographic characteristics, such as the presence of fibroids, endometriosis, and adenomyosis, were comparable between women with and without endometrial polyps. 

The likelihood of having polyps was significantly associated with a higher BMI with odds ratio (OR) of 1.06. Similarly, the use of menopausal hormone therapy was associated with greater probability of having endometrial polyps (OR 1.67). 

Clinicians should therefore be aware of the possibility of endometrial polyps in postmenopausal women undergoing hysterectomy for uterovaginal prolapse, even in the absence of symptoms. “Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk” conclude the authors. 

Reference 

1.   Gabriela M Weigel, et al. Prevalence of and risk factors for endometrial polyps among asymptomatic postmenopausal women with uterovaginal prolapse. Am J Obstet Gynecol. 2025 Feb;232(2):196.e1-196.e6. doi: 10.1016/j.ajog.2024.08.001.