The role of hormone replacement therapy in endometrial polyp formation.
OBJECTIVE
To evaluate the iatrogenic effect of different protocols of hormone replacement therapy (HRT) on endometrial polyp formation adjusting for the confounding effects of other factors such as age, parity, weight and menopausal status at menopause.


METHODS
Out of 2685 menopause patients 375 (13.9%) eligible patients were enrolled. Patients were randomized to three HRT types and three equal groups were formed. The first group received Premelle 2.5 mg (Group-I) (0.625 mg conjugated estrogen + 2.5 mg medroxyprogestorone), the second received Kliogest (Group-II) (2 mg estradiol + 1 mg norethisterone) and the last received Livial (Group-III) (2.5 mg tibolone) at least for 36 months without giving a break. After the first 18 months patients had their first office hysteroscopy and it was repeated in every 6 months until the end of third year to find out new and recurrent endometrial polyps.


RESULTS
Multiple regression analysis revealed that the type of HRT, late menopause and obesity increased the occurrence of endometrial polyps. In Group-I five polyps, in Group-II ten polyps and in Group-III two polyps were detected. There were significant differences between G-II and G-I and G-II and G-III (P < 0.05), but there was no significant difference between G-I and G-III (P > 0.05). 82.3% of the polyps were detected in the third and fourth hysteroscopic examinations. Endometrial polyp recurrence was encountered in 4 (23.5%) patients, 1 in G-I and 3 in G-II without a significant difference (P > 0.05). No malignancy was detected in any of the specimen.


CONCLUSIONS
We observed that endometrial polyp formation may be dependent on the type and dosage of the estrogen and progestogen. Especially a progestogen with high antiestrogenic activity may play an important preventive role in the development of endometrial polyps.
Oguz
S
S
Zekai Tahir Burak Woman Health, Education and Research Hospital, Ankara, Turkey.
Sargin
A
A
Kelekci
S
S
Aytan
H
H
Tapisiz
O L
OL
Mollamahmutoglu
L
L
D000328:Adult; D003280:Contraceptives, Oral, Synthetic / Q000627:therapeutic use; D004311:Double-Blind Method; D004717:Endometrium; D004958:Estradiol / Q000627:therapeutic use; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004967:Estrogens / Q000627:therapeutic use; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008525:Medroxyprogesterone / Q000627:therapeutic use; D008593:Menopause; D008875:Middle Aged; D009640:Norethindrone / Q000627:therapeutic use; D009652:Norpregnenes / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D011127:Polyps / Q000175:diagnosis*; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis
D003280:Contraceptives, Oral, Synthetic; D020847:Estrogen Receptor Modulators; D004967:Estrogens; D004966:Estrogens, Conjugated (USP); D009652:Norpregnenes; D004958:Estradiol; C027385:tibolone; D008525:Medroxyprogesterone; D009640:Norethindrone