Vaginal dysbiosis increases risk of endometrial polyp recurrence after hysteroscopic polypectomy: Study

Preoperative vaginal dysbiosis has been identified as an independent risk factor for the recurrence of endometrial polyps (Eps) following hysteroscopic polypectomy, according to the recent study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

The excessive amount of estrogen is linked to the production of Eps. Eps has also been linked to other risk factors, including as age, obesity, hypertension, and tamoxifen usage. Eps can cause infertility and irregular uterine bleeding, although it is unknown if untreated Eps can develop into a cancer. However, for big and symptomatic polyps, hysteroscopic surgery is advised.

Intervention on microbiota composition is important and promising in the treatment of gynecological disease because vaginal microbiota dysbiosis, which is defined by a rise in microbial variety and a loss of Lactobacillus dominance, is directly linked to gynecological diseases. Caini Wei and colleagues investigated if preoperative vaginal dysbiosis affects endometrial polyp recurrence following hysteroscopic polypectomy.

This observational cohort study comprised a total of 679 patients from the hospital, which is associated with the university. Every patient had a hysteroscopic polypectomy, and transvaginal ultrasonography was used every 6 months to check for the recurrence of endometrial polyps. Preoperative vaginal dysbiosis, polyp size, parity, quantity, existence of uterine fibroids, polycystic ovarian syndrome, endometriosis, and body mass index were among the extensive clinical data gathered. To evaluate the influence of these characteristics, the cohort was divided into recurrence and non-recurrence groups, and comparative analyses were performed.

Endometrial polyp recurrence was substantially correlated with preoperative vaginal dysbiosis and endometriosis (P < 0.05). Preoperative vaginal dysbiosis had an odds ratio (OR) of 3.286 (95% CI: 2.675–3.786), while endometriosis had an OR of 3.328 (95% CI: 2.567–3.643). Subsequent investigation showed that the non-recurrence group had considerably greater bacterial density, bacterial diversity, and the Lactobacillus detection rate than the recurrence group (P < 0.05).

Conversely, the recurrence group had substantially higher levels of Gardnerella vaginalis presence, enhanced leukocyte esterase activity, and Candida detection than the non-recurrence group (P < 0.05). Overall, this study found that preoperative vaginal dysbiosis is a significant risk factor for endometrial polyp recurrence following hysteroscopic polypectomy.

Source:

Wei, C., Ye, L., Tang, S., Chen, P., Huang, J., & Zhi, Z. (2025). The association between preoperative vaginal dysbiosis and endometrial polyp recurrence after hysteroscopic polypectomy: A retrospective-prospective cohort study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 307, 148–153. https://doi.org/10.1016/j.ejogrb.2025.02.002