What are the chances of endometrial polyp recurrence?

Endometrial Polyp Recurrence Rates

Endometrial polyps recur in approximately 5-7% of cases after surgical removal, with most recurrences occurring within 4-6 months of the initial polypectomy. 1, 2

Overall Recurrence Statistics

• The recurrence rate for endometrial polyps is 5.6% of all polyps and affects 6.9% of patients who undergo polypectomy, with 86% of patients experiencing only a single recurrence 1
• The mean time to first recurrence is approximately 4.36 months after the index polyp removal 1
• Most recurrences are detected within the first year of follow-up 1, 2

Risk Factors That Increase Recurrence

Age is an independent risk factor, with older patients having higher recurrence rates (OR >1, P<0.05) 2

Higher body mass index (BMI ≥28 kg/m²) significantly increases recurrence risk (OR >1, P<0.05), with patients having BMI <28 kg/m² showing lower recurrence rates 2

Larger polyp size (≥2 cm) is an independent predictor of recurrence (OR >1, P<0.05), while polyps <2 cm have lower recurrence rates 2

Endometrial thickening is an independent risk factor for recurrence after polypectomy (OR >1, P<0.05) 2

Protective Factors Against Recurrence

Postoperative progesterone therapy is an independent protective factor against recurrence (OR <1, P=0.003), with patients receiving progesterone treatment showing significantly lower recurrence rates compared to those who do not 2

Spontaneous Regression vs. Recurrence

• Approximately 23-25% of endometrial polyps may regress spontaneously if managed conservatively, particularly in younger premenopausal women 3, 4
• Spontaneous regression is more likely in patients <45 years old, premenopausal status, and polyps <2 cm 4
• All postmenopausal women in follow-up studies showed persistent polyps without spontaneous regression 4

Malignancy Risk with Recurrence

Importantly, recurrent endometrial polyps do not portend an increased risk of malignancy compared to non-recurrent polyps 1

• No malignancies were diagnosed during follow-up of patients with recurrent polyps at median follow-up of 23 months 1
• The overall malignancy risk in endometrial polyps remains low at approximately 3%, regardless of recurrence status 3

Clinical Management Algorithm

For asymptomatic premenopausal women with small polyps (<2 cm): Conservative management with surveillance is reasonable given the 23-25% spontaneous regression rate and low recurrence risk 3, 4

For symptomatic women with abnormal uterine bleeding: Polypectomy is recommended regardless of menopausal status, as these patients have higher malignancy risk 3, 5

For postmenopausal women: Surgical removal is recommended as spontaneous regression does not occur in this population 4

Consider postoperative progesterone therapy in patients with multiple risk factors (age >45, BMI ≥28, polyp ≥2 cm, endometrial thickening) to reduce recurrence risk 2

Common Pitfalls to Avoid

• Do not assume that recurrent polyps indicate malignant transformation—the malignancy risk remains unchanged 1
• Do not rely solely on histopathologic features of the initial polyp to predict recurrence, as no single feature conclusively predicts recurrence 1
• Do not overlook the protective benefit of postoperative progesterone therapy in high-risk patients 2
• Do not apply the same management strategy to premenopausal and postmenopausal women, as spontaneous regression only occurs in premenopausal patients 4