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The pathogenesis of endometrial polyps: a systematic semi-quantitative review

  • U. Indraccolo1,*,
  • R. Di Iorio2,3
  • M. Matteo4
  • G. Corona2
  • P. Greco4
  • S. R. Indraccolo2

1Operative Unit Complex of Obstetrics and Gynecology of Civitanova Marche, Area Vasta 3, Marche

2Department of Obstetrics, Gynecology, and Urology, Sapienza University of Rome

3Department of Obstetrics and Gynecology, San Pietro Fatebenefratelli Hospital, Rome

4 Department of Surgical Sciences, University of Foggia (Italy)

DOI: 10.12892/ejgo340101 Vol.34,Issue 1,January 2013 pp.5-22

Published: 10 January 2013

*Corresponding Author(s): U. Indraccolo E-mail:


The pathogenesis and natural history of endometrial polyps are not very clear. The objective of this study was to assess the opinions of international medical literature regarding the factors involved in the pathogenesis of endometrial polyps and to organize the results consistently with what is known about endometrial physiology. Materials and Methods: A systematic review was carried out with the following search engines: PubMed, OVID, Scopus, SCIELO, and AJOL. Two hundreds forty-six abstracts were selected from the literature; of these abstracts, 58 factors were extracted and set as causative, non-causative, unclear or protective link with endometrial polyps. This relation is described through a correspondence analysis and tested with a main effect hierarchical log-linear model. Results: The log-linear model resulted significant for the correspondence found with the following factors: (i) causative link (ageing, bcl-2 protein, excess weight/obesity, tamoxifen regardless of timing, relationship between estrogen receptors and progestinics, unbalanced estrogen therapy, estrogen-like effect, and unbalance between estrogens and progestinics), (ii) protective link (progestinics, antiestrogenic action), (iii) unclear link (menopause, ki-67 protein, angiogenesis, tamoxifen for a short time, tamoxifen for a long time, hormone replacement therapy (HRT), endometritis/inflammation), and (iv) non-causative link (none of the factors specifically). Discussion: Subsequently to a review of the physiology of the endometrium, the onsetting of endometrial polyps was suggested through estrogen-related and non-estrogen related ways; the two ways can overlap. The most implied factors in the development of endometrial polyps are linked with one of these or both ways.


Endometrial polyps; Pathogenesis; Estrogens; Progesterone; Apoptosis.

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U. Indraccolo,R. Di Iorio,M. Matteo,G. Corona,P. Greco, S. R. Indraccolo. The pathogenesis of endometrial polyps: a systematic semi-quantitative review. European Journal of Gynaecological Oncology. 2013. 34(1);5-22.


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