ENDOMETRIAL POLYPS IN WOMEN OF REPRODUCTIVE AGE – A MODERN ETIOPATHOGENETIC VIEW OF THE PROBLEM
(LITERATURE REVIEW)
DOI:
https://doi.org/10.11603/24116-4944.2020.2.11848Keywords:
endometrial polyp, steroid receptor, chronic endometritis, estrogen, progesterone, local endometrial hyperplasiaAbstract
Hyperproliferative diseases of the endometrium in patients of childbearing age is one of the main causes of decreased fertility and the risk of developing oncological pathology. This publication is devoted to an urgent problem, namely, local endometrial hyperplasia, that is, endometrial polyps, which today requires a thorough study and improvement of methods for diagnosing and treating this pathology in order to preserve reproductive function. The aim of the scientific search is to review the literature on risk factors, etiology and pathogenesis of endometrial polyps, the role of chronic endometritis in the development of local endometrial hyperplasia in women of reproductive age. The leading links in the etiopathogenesis of this pathology are estrogenic stimulation, which is combined with progesterone deficiency, hormone-independent proliferation, chronic inflammation, pathological neoangiogenesis, and impaired immune status in the endometrium. Study of markers of apoptosis, proliferation, receptor status and oxidative stress to determine the intensity of proliferative endometrial processes will improve tactics of patient management, and development on this basis of new forecasting methods, treatment and prevention of endometrial polyps will help prevention of recurrence of pathology and preservation of the reproductive health of women. In addition, information is presented on the role of microbial and viral agents in the development of atypical endometrial hyperplasia in women of fertile age, and on the features of the expression of steroid hormone receptors in the pathologically altered endometrium. The role of echographic and hysteroscopic methods for diagnosing endometrial polyps was evaluated. The assessment of the effect of endometrial polyps on reproductive function was carried out.
References
Gorban, N.Y., Zadorozhna, T.D., Vovk, I.B., & Zhulkevych, I.V. (2019). Morphological features of uterine polyps in females of reproductive age. Visnyk naukovykh doslidzhen – Bull. Sci. Res., 2, 47-52.
Bishtavi, A.Kh., Manukhin, I.B., & Tabakman, Yu.Yu. (2010). Sovremennyye predstavleniya o giperplazii endometriya i endometrialnoy intraepitelialnoy neoplazii [Modern concepts of endometrial hyperplasia and endometrial intraepithelial neoplasia]. Problemy reproduktsii – Problems of Reproduction, 6, 52-58 [in Russian].
Maltseva, L.I., Sharipova, R.I., Tsyplakov, D.E., & Zhelezova, M.Ye. (2017). Morfofunktsionalnoye sostoyaniye endometriya u zhenshchin s bakterialno-virusnym endometritom [Morphofunctional state of the endometrium in women with bacterial-viral endometritis]. Prakticheskaya meditsina – Practical Medicine, 7 (108), 87-91 [in Russian].
Makarov, O.V., Savchenko, T.N., Aloshkin, V.A., Afanasyev, S.S., Voropayeva, Ye.A., Melnikov, A.V., & Batiyan, T.S. (2011). Mikroflora vlagalishcha i tservikalnogo kanala u zhenshchin s polipami sheyki matki [Microflora of the vagina and cervical canal in women with cervical polyps]. Vestnik Rossiyskogo gosudarstvennogo meditsinskogo universiteta – Bulletin of the Russian State Medical University, 4, 43-47 [in Russian].
Pavlovskaya, M.A. (2015). Giperplaziya endometriya u zhenshchin fertilnogo vozrasta. Klinika, diagnostika, patogenez i vozmozhnosti terapii [Endometrial hyperplasia in women of fertile age. Clinic, diagnostics, pathogenesis and therapy possibilities]. Zhurnal Grodnenskogo meditsinskogo universiteta – Journal of Grodno Medical University, 2, 123-127 [in Russian].
Boichuk, A.V., Shadrina, V.S., & Vereshchahina, T.V. (2019). Hiperplaziia endometriia – suchasnyi systemno-patohenetychnyi pohliad na problemu (ohliad literatury) [Hyperplasia of endometrium – a modern system-pathogenetic view on the problem (literature review)]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii – Actual Problems of Pediatrics, Obstetrics and Gynecology, 1, 67-72. Retrieved from: https://doi.org/10.11603/24116-4944.2019.1.9906 [in Ukrainian].
Vovk, Y.B., Borysyuk, O.Yu., & Horban, N.Ye. (2016). Sovremennye predstavleniya o giperplazii endometriya [Modern ideas about endometrial hyperplasia]. Medychna hazeta ‘‘Zdorovia Ukrainy’’. Hinekolohiia. Akusherstvo. Reproduktolohiia – Medical newspaper "Health of Ukraine". Gynecology. Obstetrics. Reproductology, 2 (22), 70-73 [in Russian].
Horban, N.Y., Vovk, I.B., Lysiana, T.O., Ponomariova, I.H., & Zhulkevych, I.V. (2019). Peculiarities of uterine cavity biocenosis in patients with different types of endometrial hyperproliferative pathology. J. Med. Life., 12 (3), 266-270.
Beniuk, V.O., Kurochka, V.V., & Honcharenko, V.M. (2009). Suchasni pidkhody do diahnostyky hiperplastychnykh protsesiv endometriia u zhinok reproduktyvnoho viku [Modern approaches to the diagnosis of hyperplastic processes of the endometrium in women of reproductive age]. Problemy, dostizheniya i perspektivy razvitiya mediko-biologicheskikh nauk i prakticheskogo zdravookhraneniya – Problems, Achievements and Prospects for the Development of Biomedical Sciences and Practical Health Care, 145, 3, 3004-3005 [in Russian].
Dubrovina, S.O., Skachkov, N.N., Berlim, Yu.D., Zinkin, V.I., Zinkina, Ye.V., & Maklyuk, A.M. (2008). Patogeneticheskiye aspekty giperplasticheskikh protsessov v endometrii u zhenshchin s metabolicheskim sindromom [Pathogenetic aspects of hyperplastic processes in the endometrium in women with metabolic syndrome]. Rossiyskiy vestnik akushera-ginekologa – Russian Bulletin of Obstetrician-Gynecologist, 3, 41-44 [in Russian].
Boychuk, A.V., Vereshchahina, T.V., & Nikitina, I.M. (2020). Estimation of relative risk of development and informativeness of diagnostic methods of hiperproliferative processes of endometrium. Wiadomości Lekarskie (Warsav. Poland: 1960), LXXIV (9), 1600-1609.
Gorban, N.E., Vovk, I.B., Nikitina, I.M., Kondratiuk, V.K., & Yemets, N.O. (2020). Immunoglobulin indicators to viruses citomegal and genital herpes in the blood serum of women with non-atipycal endometrial hiperproliferative pathology. Wiadomości Lekarskie (Warsav. Poland: 1960), LXXIII (8), 1600-1605.
Gorban, N.Y., Kondratyuk, V.K., & Raksha, I.I. (2019). Otsinka ekhohrafichnykh pokaznykiv u zhinok z hiperproliferatyvnoiu patolohiieiu endometriia [Evaluation of ultrasound parameters in women with endometrial hyperproliferative pathology]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii – Actual Problems of Pediatrics, Obstetrics and Gynecology, 2, 32-38. Retrieved from: https://doi.org/10.11603/24116-4944.2019.2.10924 (2), 32-38 [in Ukrainian].
Lacey, J.V., Sherman, M.E., Rush, B.B., Ronnett, B.M., Ioffe, O.B., Duggan, M.A., …, & Langholz, B. (2010). Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia. J. Clin. Oncol., 28 (5), 788-792.
Zhulkevych, I.V., & Kryvokulskyi, B.D. (2018). Personalizatsiia v onkolohii: indyvidualnyi pidkhid do profilaktyky tromboembolichnykh uskladnen pry panhisterektomii [Personalization in oncology: individual approach to the prevention of thromboembolic complications during hysterectomy]. Visnyk sotsialnoi hihiieny ta orhanizatsii okhorony zdorovia Ukrainy – Bulletin of Social Hygiene and Health Protection Organization of Ukraine, 4, 11-18 [in Ukrainian].
Antonsen, S.L., Ulrich, L., & Hogdall, C. (2012). Patients with atypical hyperplasia of the endometrium should be treated in oncological centers. Gynecol. Oncol., 125 (1), 124-128.
Salman, M.C., Usubutun, A., Boynukalin, K., Yuce, K. (2010). Comparison of WHO and endometrial intraepithelial neoplasia classifications in predicting the presence of coexistent malignancy in endometrial hyperplasia. J. Gynecol. Oncol., 21 (2), 97-101.
Laurelli, G., Di Vagno, G., Scaffa, C., Losito, S., Del Giudice, M., & Greggi, S. (2011). Conservative treatment of early endometrial cancer: preliminary results of a pilot study. Gynecol Oncol., 120 (1), 43-46.
Kryvokulskyi, B.D., Zhulkevych, I.V., Kryvokulskyi, D.B., & Shkrobot, L.V. (2018). Vyvchennia vplyvu viku ta indeksu komorbidnosti na ryzyk trombotychnykh uskladnen u khvorykh na rak endometriia na dooperatsiinomu etapi [Studying the influence of age and comorbidity index on the thrombotic complications risk in patients with endometrial cancer at preoperative stage]. Visnyk naukovykh doslidzhen – Bull. Sci. Res., 2 (91), 151-153 [in Ukrainian].
Chernukha, G.E., Dumanovskaya, M.R., Burmen- skaya, O.V., Shubina, E.S., Kogan, E.S., & Trofimov, D.Yu. (2013). Ekspresiya genov, reguliruyushchikh apoptoz, pri raznykh tipakh giperplazii endometriya i endometroidnoy kartsinome [Expression of genes regulating apoptosis in different types of endometrial hyperplasia and endometrioid carcinoma]. Akusherstvo i ginekologiya – Obstetrics and Gynecology, 1, 63-69 [in Russian].
Walther-António, M.R., Chen, J., Multinu, F., Hokenstad, A., Distad, T.J., Cheek, E.H., ..., & Chia, N. (2016). Potential contribution of the uterine microbiome in the development of endometrial cancer. Genome Med., 8 (1), 122.
Moreno, I., Cicinelli, E., Garcia-Grau, I., Gonzalez-Monfort, M., Bau, D., Vilella, F., …, & Simon, C. (2018). The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am. J. Obstet. Gynecol., 218 (6), 602.
Kutsenko, I.I., Arakelyan, E.R., Borovikov, I.O., & Safronova, Yu.S. (2014). Sostoyaniye mikrotsenoza polosti matki u patsiyentok s prostymi giperplaziyami endometriya [The state of microcenosis of the uterine cavity in patients with simple endometrial hyperplasia]. Sovremennyye problemy nauki i obrazovaniya – Modern Problems of Science and Education, 2, 283.
Podolskyi, Vl.V., Lisyana, T.O., & Ponomarova, I.H. (2015). Stan mikrobiotsenozu urohenitalnykh orhaniv u zhinok z porushenniam reproduktyvnoho zdorovia ta zminamy vehetatyvnoho homeostazu [The state of the microbiocenosis of urogenital organs in women with reproductive health disorders and changes in autonomic homeostasis]. Zdorovye zhenshchiny – Women’s Health, 2, 142-150 [in Ukrainian].
Ponomarenko, K.Yu. (2017). Retseptivnost endometriya u zhenshchin s narusheniyami v reproduktivnoy sisteme [Endometrial receptivity in women with reproductive disorders]. Zhurnal akusherstva i zhenskikh bolezney – Journal of Obstetrics and Women's Diseases, 66, 4, 90-97 [in Russian].
Vovk, I.B., Kornatska, A.H., Lysyana, T.O., Horban, N.Ye., & Ponomarov, I.H. (2016). Osoblyvosti aerobnoi ta anaerobnoi mikroflory u zhinok z hiperproliferatyvnymy zakhvoriuvanniamy matky i endometriia [Peculiarities of aerobic and anaerobic microflora in women with hyperproliferative diseases of the uterus and endometrium]. Zdorove zhenshchyny – Women’s Health, 2, 102-106 [in Ukrainian].
Franasiak, J.M., & Scott, R.T.Jr. (2015). Reproductive tract microbiome in assisted reproductive technologies. Fertil. Steril., 104 (6), 1364-1371.
Dobrokhotova, Yu.E., & Yakubova, K.K. (2018). Mikrobiota reproduktivnogo trakta i giperplasticheskiye protsessy endometriya (obzor literatury). RMZh. Meditsinskoye obozreniye – RMJ. Medical Review, 10, 14-16 [in Russian].
Reed, S.D., Newton, K.M., Clinton, W.L., Epplein, M., Garcia, R., Allison, K., ..., & Weiss, N.S. (2009). Incidence of endometrial hyperplasia. Am. J. Obstet. Gynecol., 200, 678, e1–6.
Radzinskiy, V.Ye., Petrov, Yu.A., Kalinina, Ye.A., Shirokova, D.V., & Polina, M.L. (2017). Patogeneticheskiye osobennosti makrotipov khronicheskogo endometrita [Pathogenetic features of the macrotypes of chronic endometritis]. Kazanskiy meditsinskiy zhurnal – Kazan Medical Journal, 98 (1), 27-34 [in Russian].
Pal, L., Niklaus, A.L., Kim, M., Pollack, S., & Santoro, N. (2008). Heterogeneity in endometrial expression of aromatase in polyp-bearing uteri. Hum. Reprod., 23 (1), 80-84.
Maia, H.Jr., Pimentel, K., Silva, T.M., Freitas, L.A., Zausner, B., Athayde, C., & Coutinho, E.M. (2006). Aromatase and cyclooxygenase-2 expression in endometrial polyps during the menstrual cycle. Gynecol. Endocrinol., 22 (4), 219-224.
Gorban, N.Ye. (2018). Polip i giperplaziya endometriya – etiopatogeneticheskiye aspekty ratsionalnogo podkhoda k probleme [Polyp and endometrial hyperplasia – etiopathogenetic aspects of a rational approach to the problem]. Visnyk naukovykh doslidzhen – Bull. Sci. Res., 4. Retrieved from https://doi.org/10.11603/2415-8798.2017.4.8246 [in Ukrainian].
Radzinskiy, V.Ye., Petrov, Yu.A., Polina, M.L. (2017). Khronicheskiy endometrit: sovremennyye aspekty [Chronic endometritis: modern aspects]. Kubanskiy nauchnyy meditsinskiy vestnik – Kuban Sci. Med. Bull., 24 (5), 69-74 [in Russian].
Seshadri, S., El-Toukhy, T., Douiri, A., Jayaprakasan, K., & Khalaf, Y. (2015). Diagnostic accuracy of saline infusion sonography in the evaluation of uterine cavity abnormalities prior to assisted reproductive techniques: a systematic review and meta-analyses. Hum. Reprod. Update, 21 (2), 262-274.
Fang, L., Su, Y., Guo, Y., & Sun, Y. (2013). Value of 3-dimensional and power Doppler sonography for diagnosis of endometrial polyps. J. Ultrasound Med., 32 (2), 247-255.
Ahmadi, F., Zafarani, F., Haghighi, H., Niknejadi, M., & Dizaj, A.V.T. (2011). Application of 3D ultrasonography in detection of uterine abnormalities. Int. J. Fertil. Steril., 4 (4), 144-147.
American Association of Gynecologic Laparoscopists. (2012). AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J. Minim. Invasive Gynecol., 19, (1), 3-10.
Makris, N., Skartados, N., Kalmantis, K., Mantzaris, G., Papadimitriou, A., & Antsaklis, A. (2007). Evaluation of abnormal uterine bleeding by transvaginal 3-D hysterosonography and diagnostic hysteroscopy. Eur. J. Gynaecol. Oncol., 28 (1), 39-42.
Jansen, F.W., de Kroon, C.D., van Dongen, H., Grooters, C., Louwé, L., & Trimbos-Kemper, T. (2006). Diagnostic hysteroscopy and saline infusion sonography: prediction of intrauterine polyps and myomas. J. Minim. Invasive Gynecol., 13 (4), 320-324.
El-Sherbiny, W., El-Mazny, A., Abou-Salem, N., & Mostafa, W.S. (2015). The diagnostic accuracy of two- vs three-dimensional sonohysterography for evaluation of the uterine cavity in the reproductive age. J. Minim. Invasive Gynecol., 22 (1), 127-131.
Abou-Salem, N., Elmazny, A., & El-Sherbiny, W. (2010). Value of 3-dimensional sonohysterography for detection of intrauterine lesions in women with abnormal uterine bleeding. J. Minim. Invasive Gynecol., 17 (2), 200-204.
Preutthipan, S., & Linasmita, V. (2003). A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. J. Obstet. Gynaecol. Res., 29 (1), 33-37.
Svirsky, R., Smorgick, N., Rozowski, U., Sagiv, R., Feingold, M., Halperin, R., & Pansky, M. (2008). Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology? Am. J. Obstet. Gynecol., 199 (2), 115.
Elias, R.T., Pereira, N., Karipcin, F.S., Rosenwaks, Z., & Spandorfer, S.D. (2015). Impact of newly diagnosed endometrial polyps during controlled ovarian hyperstimulation on in vitro fertilization outcomes. J. Minim. Invasive Gynecol., 22 (4), 590-594.
Bosteels, J., Kasius, J., Weyers, S., Broekmans, F.J., Mol, B.W.J., & D'Hooghe, T.M. (2015). Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst. Rev., 2, CD009461.
Carneiro, M.M. (2014). What is the role of hysteroscopic surgery in the management of female infertility? A review of the literature. Surg. Res. Pract., 2014, 6, ID 105412.
Deans, R., & Abbott, J. (2010). Review of intrauterine adhesions. J. Minim. Invasive Gynecol., 17 (5), 555-569.
Taylor, E., & Gomel, V. (2008). The uterus and fertility. Fertil. Steril., 89 (1), 1-16.
Afifi, K., Anand, S., Nallapeta, S., & Gelbaya, T.A. (2010). Management of endometrial polyps in subfertile women: a systematic review. Eur. J. Obstet. Gynecol. Reprod. Biol., 151 (2), 117-121.
Bosteels, J., Kasius, J., Weyers, S., Broekmans, F.J., Mol, B.W.J., & D'Hooghe, T.M. (2015). Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst. Rev., 2, CD009461.
Pérez-Medina, T., Bajo-Arenas, J., Salazar, F., Redondo, T., Sanfrutos, L., Alvarez, P., & Engels, V. (2005). Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum. Reprod., 20 (6), 1632-1635.
Bosteels, J., Kasius, J., Weyers, S., Broekmans, F.J., Mol, B.W.J., & D'Hooghe, T.M. (2013). Treating suspected uterine cavity abnormalities by hysteroscopy to improve reproductive outcome in women with unexplained infertility or prior to IUI, IVF, or ICSI. Gynecol. Surg., 10 (3), 165-167.
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