From the Guidelines
To prevent endometrial polyps, maintaining a healthy weight and exercising regularly is crucial, as obesity increases estrogen levels which can stimulate polyp growth, and considering hormonal contraceptives like combined oral contraceptives or progesterone-only options, such as the levonorgestrel IUD, can help regulate hormonal balance and reduce polyp formation. The most recent and highest quality study, 1, suggests that continuous progestin-based therapy may be considered for young patients with endometrial hyperplasia who desire fertility preservation, which can also help prevent endometrial polyps.
Key Prevention Strategies
- Maintaining a healthy weight through regular exercise and a balanced diet, as obesity is a significant risk factor for endometrial polyps, and excess estrogen stimulation of the endometrium without adequate progesterone opposition is a key mechanism behind polyp formation 1.
- Considering hormonal contraceptives, such as combined oral contraceptives or progesterone-only options, like the levonorgestrel IUD, to regulate hormonal balance and reduce polyp formation, as these methods can help oppose estrogen stimulation with progesterone, thereby reducing the risk of polyp development.
- Regular gynecological check-ups with transvaginal ultrasounds are recommended for early detection, especially for women who have had polyps before or are at increased risk due to factors like tamoxifen use, hypertension, or diabetes, as early detection can improve outcomes and reduce the risk of complications 1.
Special Considerations
- Women taking tamoxifen, a breast cancer medication that increases polyp risk, should undergo more frequent monitoring, as the risk of endometrial polyps and hyperplasia is higher in these patients, and close surveillance can help detect any abnormalities early 1.
- Managing conditions like hypertension and diabetes is also important, as these are associated with higher polyp risk, and controlling these conditions can help reduce the overall risk of developing endometrial polyps, thereby improving morbidity, mortality, and quality of life outcomes.
By prioritizing these strategies, individuals can reduce their risk of developing endometrial polyps and improve their overall health outcomes, with a focus on minimizing morbidity, mortality, and maximizing quality of life.
From the FDA Drug Label
- Use with Estrogen Studies of the addition of a progestin product to an estrogen replacement regimen for seven or more days of a cycle of estrogen administration have reported a lowered incidence of endometrial hyperplasia Morphological and biochemical studies of endometrial suggest that 10–13 days of a progestin are needed to provide maximal maturation of the endometrium and to eliminate any hyperplastic changes. The methods for preventing endometrial polyps (endometrial hyperplasia) include:
- Adding a progestin product to an estrogen replacement regimen for 7 or more days of a cycle of estrogen administration
- Using a progestin for 10-13 days to provide maximal maturation of the endometrium and eliminate hyperplastic changes 2
From the Research
Methods for Preventing Endometrial Polyps
There are several methods that may help prevent endometrial polyps, including:
- The use of a levonorgestrel-impregnated intrauterine system (LNG-IUS), which has been shown to reduce the occurrence of hyperplastic polyps 3
- Hormone replacement therapy (HRT) with a progestogen that has high antiestrogenic activity, which may play a preventive role in the development of endometrial polyps 4
- Avoiding certain types of HRT, such as those with high estrogen doses, which may increase the risk of endometrial polyp formation 4
Risk Factors for Endometrial Polyps
Certain factors may increase the risk of developing endometrial polyps, including:
- Menopause 5
- Abnormal uterine bleeding 5
- Hypertension 5
- Obesity 5, 4
- Diabetes mellitus 5
- Tamoxifen use 5
- Late menopause 4
Diagnosis and Treatment of Endometrial Polyps
Endometrial polyps can be diagnosed using transvaginal ultrasonography or hysteroscopy, and can be treated with hysteroscopic excision 5, 6, 7. In some cases, asymptomatic polyps may regress spontaneously, and conservative management may be an option 5, 6.