Clinical and Reproductive Outcomes Following Hormone Treatments after Hysteroscopic Endometrial Polypectomy
Authors: Liu Jie , Xiong Wei , Dong Xue , Chen Yihong , Chen Hengxi , Tan Xin 
Published: June 2024

Objective: To investigate whether hormone treatments following
hysteroscopic resection of endometrial polyps can further effectively
alleviate clinical symptoms and enhance reproductive outcomes and to
analyze the factors that influence successful conception in such cases.
Design: A large-scale, single-center, retrospective cohort
study was conducted in the Day Surgery Department of a tertiary teaching
hospital. Setting: The study included pre-menopausal women aged
18-55 with endometrial polyps who underwent hysteroscopic polypectomy.
Following the procedure, patients were prescribed oral
progesterone/dydrogesterone, combined oral contraceptives, a
levonorgestrel-releasing intrauterine system, or received no
postoperative medication. Population: A total of 1021 patients
were enrolled in the study. Methods: Data were collected and
analyzed using SPSS Statistics 26.0 software. Main Outcome
Measures: Data including postoperative menstrual status and
reproductive outcomes. Results: Among 1021 patients, 222
individuals received either progesterone or dydrogesterone following
hysteroscopy, 173 received combined oral contraceptives, 84 were fitted
with a levonorgestrel-releasing intrauterine system, and 542 did not
receive any postoperative medication. Most patients in the progesterone
group (94.6%) and the combined oral contraceptives group (83.8%)
received short-term drug treatment within 3 months after the
hysteroscopic polypectomy. Prior to treatment, 696 patients (68.2%) had
experienced abnormal uterine bleeding. The percentage of patients with
resolved abnormal uterine bleeding symptoms post-operation was 78.2% in
the progesterone group, 70.2% in the combined oral contraceptives
group, 22.2% in the levonorgestrel-releasing intrauterine system group,
and 73.4% in the no-medication group. There was no significant
difference among the progesterone group, combined oral contraceptives
group and no-medication group (p＞0.05). Despite having the lowest rate
of relief for abnormal uterine bleeding (p=0.000),
levonorgestrel-releasing intrauterine system exhibited the highest rate
of normal endometrial ultrasound images during follow-up (p=0.001). Out
of the 300 participants aiming to conceive, a successful pregnancy was
achieved by 78.3%. The success rates of pregnancy were higher in both
the progesterone group (82.9%) and the combined oral contraceptives
group (85.0%) compared to the no-medication group (74.7%). However,
statistical analysis revealed no significant difference (p=0.179) among
the groups. Increasing age (OR 1.153, 95% CI 1.078-1.234, p=0.000),
persistent abnormal uterine bleeding (OR 5.742, 95% CI 2.269-14.531,
p=0.000), and reduced menstrual volume after treatment (OR 3.810, 95%
CI 1.398-10.383, p=0.009) identified as unfavorable factors for
successful pregnancy. Conclusions: Adding short-term combined
oral contraceptive or progesterone after hysteroscopy does not
significantly increase the long-term remission of abnormal uterine
bleeding symptoms or the pregnancy rates compared to hysteroscopy alone.
The LNG-IUS seems to be most beneficial in preventing the postoperative
recurrence of EPs. Funding: None. Keywords:
Endometrial polyps, Hysteroscopic polypectomy, Abnormal uterine
bleeding, Pregnancy, Hormone medication