Журнал клинических случаев

Factors and Clinical Scenarios Possibly Related to Endometrial Micropolyps and Chronic Endometritis

Abstract

Abdel-Gadir A

Objectives: To study factors and clinical scenarios possibly related to the development of endometrial micropolyps, hence chronic endometritis.
Materials and methods: 197 patients with abnormal uterine bleeding, infertility or recurrent miscarriages were studied by early follicular phase transvaginal ultrasound scan examinations and hysteroscopy. Presence of endometrial micropolyps was assessed in relation to sexual intercourse frequency, regular vaginal washing, parity, previous pelvic infection and previous uterine surgery. The likelihood of patients to use vaginal washing was examined against the other four factors. Furthermore, the association of micropolyps with other uterine pathologies was examined. Cross tabulation with chi square test, binary logistic regression analysis and odds ratio was used as appropriate to examine the data.
Results: Hysteroscopic examination revealed 81 cases with micropolyps not diagnosed previously by transvaginal ultrasound scan examinations. 56 of them (69.14%) presented with abnormal uterine bleeding, 13 with infertility (16.04%) and 12 with repeated miscarriages (14.81%), p=0.012. Cross tabulation and chi square test showed micropolyps were significantly associated to parity, sexual intercourse frequency, previous pelvic infection and regular vaginal washing, but not previous uterine surgery. Furthermore, binary logistic regression analysis showed vaginal washing was the most significant factor in this group. It also showed that micropolyps were significantly associated to the presence of endometrial polyps (p=0.022) and symptomatic patients with negative ultrasound findings (p=0.049). Patients who had more frequent sexual intercourse showed high odds ratio to use regular vaginal washing, but not the other three groups.
Conclusion: Women should be advised against vaginal washing, especially those at risk of chronic endometritis. Micropolyps might be precursors to endometrial polyps because of the close association between the two. Chronic endometritis might trigger clonal rearrangements and translocations between the four stromal chromosomes already suspected of initiating endometrial polyps’ development.