{"paper_id":"cdbc5288-3cc0-4266-8d24-186f8cf5ebbb","body_text":"| 125\nORIGINAL ARTICLE\nReproductive challenges of endometrial polyps: the influence \nof women’s age and associated risk factors\n Sladjana Mihajlovic\niD 1,2, Svetlana Vujovic2,3, Mina Hagen\niD 4, Milan Lackovic\niD 1, \nSanja Milic\niD 1, Antoan Stefan Sojat\niD 3, Kristina Saravinovska\niD 2,3, Natalija Antic\niD 3,  \nDjurdjica Kalicanin\niD 1, Ljiljana V. Marina\niD 2,3\n1 Clinical Hospital Centre “Dr Dragisa Misovic - Dedinje”, Hospital for Gynecology and Obstetrics, Belgrade, Serbia\n2 University of Belgrade, Faculty of Medicine, Belgrade, Serbia\n3 Clinic of Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia\n4 Department of Psychology, Faculty of Media and Communications, Singidunum University\nSubmitted: 25 October 2024\nRevised: 04 June 2025\nAccepted: 06 June 2025\nPublished: 30 June 2025 \nCopyright: © 2025 Medicinska istraživanja\nLicence:\nThis is an open access article distributed under \nthe terms of the Creative Commons Attribution \nLicense (https://creativecommons.org/licenses/\nby/4.0/), which permits unrestricted use, \ndistribution, and reproduction in any medium, \nprovided the original author and source are \ncredited.\n        Correspondence to:\nSladjana Mihajlovic\nClinical Hospital Centre “Dr Dragisa Misović - \nDedinje” , Hospital for Gynecology and Obstetrics, \n11000 Belgrade\nE-mail: drsladjanamihajlovic@gmail.com\nMedicinska istraživanja 2025; 58(2):125-131 | DOI: 10.5937/medi58-53292 OPEN  ACCESS\nMedical Research | Published by Faculty of Medicine University of Belgrade\n \nUNIVERSITY OF BELGRADEУНИВЕРЗИТЕТ У БЕОГРАДУ\nМЕДИЦИНСКИ\nФАКУЛТЕТ\nFACULTY OF\nMEDICINE\nCheck for\nupdates\nSummary \nIntroduction / Aim:  Endometrial polyps (EPs) are abnormal benign \ngrowths that originate from the endometrium. Risk factors associated \nwith EPs are hormonal changes related to ageing, Tamoxifen use, hor-\nmone replacement therapy, overweight or obesity. The exact causal \nrelationship between EPs and infertility remains unclear, but multi -\nple mechanisms including mechanical obstruction and biochemical \nchanges are proposed. The “gold standard” for diagnosing and treat-\ning EPs is hysteroscopy. This study aims to provide comprehensive \nunderstanding of the interplay between EP , age and infertility.\nMaterial and methods: Our study included 301 women undergoing \nhysteroscopic polypectomy due to infertility treatment, which were \ndivided into two groups based on their age (age ≤ 35 and age > 35).  \nData were collected from patients’ medical histories and pathology \nreports. Study variables included infertility type, type 2 diabetes mel-\nlitus, insulin resistance, polycystic ovary syndrome, endometriosis, \nhypothyreosis, previous unsuccessful intrauterine insemination and \nin vitro fertilization (IVF), menstrual cycle irregularities and abnormal \nuterine bleeding, polyp size and histopathology type. \nResults: At least one out of five participants had insulin resistance, \npolycystic ovary syndrome and abnormal uterine bleeding. Endome-\ntriosis, insulin resistance and primary infertility were more common \nin the younger group then in the older group. Previous history of \nunsuccessful IVF cycles, hypothyreosis and secondary infertility were \nassociated with older age.\nConclusion: The prevalence of EPs tends to increase with advanced \nwomen’s age, period marked by natural decline in ovarian reserve, \nhormonal changes and changes in endometrial health. Addressing \nEPs through appropriate diagnostic and therapeutic measure and \nunderstanding the hormonal influence on EPs and EM is crucial for \nimproving fertility outcomes. \nKeywords: endometrial polyps, infertility, hysteroscopy\nCite this article as: Mihajlovic S, Vujovic S, Hagen M, Lackovic M, Milic S, Sojat A. S, Saravinovska K, Antic N, Kalicanin Dj, Marina Lj. V. Reproductive challenges of endometrial polyps: the influence of \nwomen’s age and associated risk factors; Medicinska istraživanja 2025; 58(2):125-131 DOI: 10.5937/medi58-53292\nISSN 0301-0619 | E-ISSN 0301-0619 https://medicalresearch.med.bg.ac.rs/\n\n126 |\nMedicinska istraživanja 2025; 58(2):125-131\nINTRODUCTION \nEndometrial polyps (EPs), also known as uterine polyps, \nare abnormal growths that originate from the endometri -\num. They consist of glands, stroma, and blood vessels. The \nsize of EPs can range significantly, they can be as small as 5 \nmm, but they can also fulfill the entire uterine cavity. Based \non their attachment to the uterine surface, there are two \nmain types of EPs. If an EP is attached by a narrow-elon -\ngated pedicle, then it is known as pedunculated. Howev -\ner, if they have a large flat base, they are known as sessile. \nThe gross morphological appearance of these polyps can \nvary, but they often present as smooth structures with a \ntan to yellow coloration. EPs are quite common among \nwomen, with estimates suggesting they affect about 25% \nof women. While EPs can occur at any age, they are sta -\ntistically more prevalent in women aged 40 to 49 years, \nprimarily due to hormonal changes and fluctuations that \nthis age group tends to experience (1,2). Estrogen’s role \nin stimulating endometrial growth and thickening each \nmonth makes it a significant factor in the development of \nEPs. Understanding and managing conditions that result \nin elevated estrogen levels are essential in minimizing the \nrisk of polyp formation and ensuring reproductive health \n(3). Aside from hormonal changes related to aging, other \nrisk factors associated with EPs have also been identified, \nsuch as Tamoxifen use and hormone replacement therapy \n(HRT). There is an increased risk of EPs in women who \nare overweight or obese as well. Higher levels of adipose \ntissue can lead to increased estrogen production, which \nmay contribute to the development of polyps (3,4).  \nEPs are typically asymptomatic but they can manifest \nas abnormal uterine bleeding (AUB). The AUB include \nirregular menstrual periods (unpredictable timing and \nflow), unusually heavy flow during menstrual period, \nbleeding or spotting between periods, vaginal spotting \nor bleeding after menopause. AUB may be the prima -\nry symptom of EPs, occurring in more than a half of all \nwomen with the condition, and its incidence appears to \nincrease with age (5,6).  \nCorrelation between EPs and infertility is a special \nconcern. While the exact causal relationship between EPs \nand infertility remains unclear, multiple mechanisms in -\ncluding mechanical obstruction and biochemical changes \nare proposed. EPs may induce an inflammatory response \nin the endometrium, which could disturb embryo im -\nplantation, similar to the effects seen with an intrauter -\nine device. Also, EPs have been found to exhibit altered \nlevels of matrix metalloproteinases (MMPs), cytokines \nlike interferon gamma, and proteins such as glycodelin \nand placenta protein 14. These biochemical changes can \ninterfere with sperm function, inhibit embryonic devel -\nopment, and affect the endometrial environment needed \nfor successful implantation (1,7).   \nHysteroscopy with guided biopsy not only serves \nas the definitive method for diagnosing EPs but also fa -\ncilitates precise localization and allows for immediate \ntherapeutic intervention through simultaneous resec -\ntion. These advantages underscore its status as the “gold \nstandard” in clinical practice for managing EPs. While \nthere is still disagreement in the literature regarding the \nroutine removal of EPs before attempting pregnancy \n(both natural and assisted), there is a tendency towards \nremoving polyps before initiating assisted reproductive \ntechnologies (ART) such as intrauterine insemination \n(IUI) and in vitro fertilization (IVF). Therefore, the de -\ncision-making process should involve a thorough assess -\nment of each patient’s unique circumstances and prefer -\nences, guided by current evidence-based practices and \nclinical judgment (8).  \nThis study aims to provide comprehensive under -\nstanding of the interplay between EP, age and infertility, \nultimately guiding more effective diagnostic and ther -\napeutic strategies to enhance reproductive success for \nwomen experiencing such challenges. \nMATERIAL AND METHODS \nStudy design and participants \nThe study was performed in the Clinical Hospital Cen -\ntre (CHC) “Dr Dragisa Misovic - Dedinje” in Belgrade, \nSerbia. It included 301 women undergoing hysteroscopic \npolypectomy due to infertility treatment. The age ranged \nfrom 24 to 44 (mean 35.91 ± 4.63). Patients were treated \nat the Hospital of Gynecology and Obstetrics and recruit -\ned from 2019 to 2024. The study was approved by the \nCHC’s Institutional Review Board (No 18328/4-2024, \nDate: 29.08.2024).  \nStudy participants were divided into two groups \nbased on their age.  \nThe first, younger group (age ≤ 35) consisted of 131 \nparticipants where age ranged from 24 to 35 (mean 31.50 \n± 3.00). Second, older group (age > 35) included 170 par-\nticipants, with age ranging from 36 to 44 (mean 39.31 ± \n2.12).  \nStudy inclusion and exclusion criteria \nStudy included women aged between 18 and 45 who were \ntreated during a five year long time frame at the CHC \n“Dr Dragisa Misovic - Dedinje”. Women older than 45 or \nyounger than 18 were excluded from the study. All wom -\nen included in the study were normal weight and had \nbody mass index (BMI) of between 18.5 and 24.9 kg/m2. \nObese women were excluded.    \nStudy variables \nData on infertility type (primary or secondary), type 2 \ndiabetes mellitus, insulin resistance, polycystic ovarian \n\n| 127\nReproductive challenges of endometrial polyps: the influence of women’s age and associated risk factors\nsyndrome, endometriosis, hypothyreosis, previous un -\nsuccessful intrauterine insemination and in vitro fertil -\nization, previous hysteroscopic polypectomy, menstrual \ncycle irregularities and abnormal uterine bleeding, were \ncollected from patients’ medical histories. Data on polyp \nsize and histopathology type were collected from pathol -\nogy reports.\nStatistical analysis \nDescriptive statistics are presented as frequencies and \npercentages for categorical data, and  as mean, medi -\nan, SD and range for continuous data. The descriptives \nwere presented for the total sample, and for the younger \nand older group of participants. To test the relationship \nbetween age groups and other relevant variables in our \nstudy, we used Fisher’s Exact Test for categorical data and \nMann-Whitney U test for continuous data. A significance \nlevel of p < 0.05 was set. Statistical analysis was conduct -\ned using IBM SPSS version 23.0.  \nRESULTS \nThe characteristics and prevalence of comorbid-\nities, previous ART and hysteroscopy procedures \nand menstrual cycle disorders in the sample  \nIn order to describe the characteristics of the age groups \nregarding significant variables related to infertility, we \ncalculated the number of conditions within two groups \nand in the total sample. In order to examine the relation -\nship between age groups and significant variables, we \nperformed Fisher’s Exact test. The results including fre -\nquencies, percentages and p values (two-tailed) are dis -\nplayed in Table 1. \nLooking at the results for the whole sample present -\ned in Table 1, we can observe that at least one out of five \nparticipants have insulin resistance, PCOS and abnormal \nuterine bleeding – and those were the most common con -\nditions. The majority of the sample (85.4%) had a regular \nmenstrual cycle.\nInspecting the differences between the age group, we \ncan see that in the younger group (age ≤ 35), the more \ncommon conditions are endometriosis (p = 0.011), in -\nsulin resistance (p = 0.021) and primary infertility (p = \n0.017). The prevalence for endometriosis in the younger \ngroup was 8.4% compared to the 1.4% in the older group. \nInsulin resistance was present in 30.5% of cases in the \nyounger group, compared to the 18% in the older group. \nRegarding primary infertility, there were 90.1% diag -\nnosed participants in the younger group, compared to the \n79.4% in the older group.\nIn the older group there was a significantly higher \nnumber of cases with hypothyroidism (p = 0.014), previ -\nous unsuccessful IVF (p < 0.001) and secondary infertil -\nity (p = 0.017). Every fourth patient had hypothyroidism \n(25.3%) in the older group compared to every sixth patient \n(13.7%) in the younger group. The prevalence of previous \nunsuccessful IVF was 18.8% in the older group compared \nto the 4.6% in the younger group. Regarding secondary \ninfertility there were 20.6 % diagnosed women in the old -\ner group compared to the 9.9% in the younger group.\nThe characteristic polyp size and histopathology \ntype in the sample\nThe size of EPs can vary significantly; they can be as small \nas 5mm, but they can also fulfill the entire uterine cavity. \nEPs are usually benign, but in some cases, they can be \nassociated with a risk of malignancy, especially in post -\nmenopausal women or in those with abnormal bleeding \n  total sample\n(n = 301)\nage ≤ 35\n(n = 131)\nage > 35\n(n = 170)\np\n  N.\nyes (%)\nN.\nyes (%)\nN.\nyes (%)\nendometriosis 14 (4.7) 11 (8.4) 3 (1.8) 0.011\ninsulin resistance 72 (23.9) 40 (30.5) 32 (18 . 8) 0.021\nPCOS 73 (2 4. 3) 38 (29.0) 35 (20.6) 0.104\nhypothyroidism 61 (20. 3) 18 (13.7) 43 (25. 3) 0.014\nIUI 3 (1.0) 3 (2 . 3) 0 (0) 0.081\nIVF 38 (12 . 6) 6 (4.6) 32 (18 . 8) <0.001\nprevious hysteroscopic polypectomy 4 8 (15 .9) 16 (12 . 2) 32 (18 . 8) 0.153\nregular menstrual cycle 257 (85.4) 115 (87.8) 142 (83. 5) 0.327\nabnormal uterine bleeding 79 (26.2) 33 (25.2) 4 6 (27.1) 0.792\nprimary infertility 2 52 (8 4.1) 118 (9 0 .1) 135 (79.4) 0.017\nsecondary infertility 4 8 (15 .9) 13 (9.9) 35 (20.6) 0.017\nTable 1. Frequencies, percentages of participants with endometriosis, insulin resistance, PCOS, hypothyroidism, unsuccessful IUI and IVF, \nprevious hysteroscopic polypectomy, regular menstrual cycle, abnormal uterine bleeding withing total sample and subsamples and statistical \nsignificance (p value, two tailed) of Fisher’s Exact test.\nNote: PCOS – polycystic ovarian syndrome; IUI – unsuccessful intrauterine insemination; IVF – unsuccessful in vitro fertilization   \n\n128 |\nMedicinska istraživanja 2025; 58(2):125-131\npatterns. In the total sample the size of the polyp ranged \nfrom 2 mm to 50 mm (M = 12.88; SD = 6.57; Median = \n10). We used Mann-Whitney U test to discover whether \nthere was a significant difference in average size between \nthe age groups. There were no significant differences (p \n= .813) between the Mean Rank in the younger group \n(149.67) compared to the older group (152.03).\nWe also checked the histopathology type and com -\npared the groups. In the total sample in 96.7% of cases it \nwas confirmed polyp, and in 3.3% cases other diagnosis. \nIn the younger group the prevalence of other diagnosis \nwas 3.1% whereas in the older group was 3.5%. The re -\nsults of Fisher’s Exact test showed that these differences \nwere not statistically significant (p = 1.000).\nAssociation Between Endometriosis and Type of \nInfertility\nTo investigate the potential association between endome-\ntriosis prevalence and the type of infertility (primary vs. \nsecondary), we performed Fisher’s Exact Test. The prev -\nalence of endometriosis was 5.1% among patients with \nprimary infertility and 2.1% among those with secondary \ninfertility. However, this difference was not statistically \nsignificant (p = 0.706).\nDISCUSSION \nOur study included 301 women dealing with infertility, \nwho were diagnosed with EPs. Subjects were divided in \ntwo subgroups, based on age, which was defined for the \npurpose of this study as older or younger than 35. A to -\ntal of 12 variables related to EP and infertility treatment \nwere assessed, but statistical relevance was found for only \ntwo parameters, concomitant presence of endometriosis \nand the history of previous IVF failure.  \nThe age for the diagnosis of type 2 diabetes mellitus \n(T2DM) has decreased over the last few decades (9). \nGuidelines specifically created for this group of patients \nare still lacking, and recommendations are primarily ex -\ntrapolated from the evidence in older people (10). How -\never, only three cases of T2DM were observed in the \ngroup of women who were older than 35, and there were \nno participants with T2DM among participants in the \nfirst group (35 or younger) so therefore statistical com -\nparison between the two groups was not performed.\nWomen’s fertility starts to decline after the age of 30, \nand after the age of 35 the fertility decline rate accelerates. \nThe underlying etiology is associated with the oocyte \nnumber and quality depletion, and this is the primary \nreason why women over 35 are more commonly seeking \nfertility counselling and are more commonly exposed to \nthe methods of assisted reproduction (11). The highest \nnumber of ART procedures in the United States (US) are \nactually carried out among women aged between 35 and \n40. Centers for Disease Control and Prevention (CDC) \nreported the average age of women undergoing ART pro -\ncedures to be 36.2 years. Women aged between 35 and \n40 represent 43.3% of all women undergoing ART proce -\ndures in the US (12). \nAdvanced women’s age is a well-known risk factor for \nprolonged time to conception. Without involvement of \nART techniques before the age of 30 women have approx-\nimately 85% chance to conceive within one year, while \nafter the age of 35 these chances drop to 66%, and go \nfurther down reaching a probability of 44% by the age of \n40. Unfortunately, reproductive challenges at this age are \nnot limited only to the conception difficulties. At this age \nwomen deal with other burdens of unfavorable pregnancy \noutcomes as well, such as a miscarriage. More than a quar-\nter of all clinical pregnancies terminate as a miscarriage \nat the age of 40, compared to 16% at the age of 30 (11,13). \nOur results are in unison with the fact that advanced \nwomen’s age is associated with higher number of unsuc -\ncessful IVF cycles (14), and this is the most probable ex -\nplanation why women over 35 in our study did undergo \nIVF procedures more often compared to the group of \nwomen who were 35 years or younger. \nOur study showed higher prevalence of endometriosis \nin younger patients with EP. Both EP and endometriosis \nare conditions related to the uterine lining, but they are \ndistinct in their nature and presentation. While EP are \ngrowths that occur in the endometrium, endometriosis \nis a condition where endometrial tissue grows outside \nthe uterus, causing pain, irregular bleeding and fertility \nissues. Even though EP and endometriosis are two dif -\nferent conditions, there’s often an overlap in clinical pre -\nsentation and possibly in the pathophysiological mecha -\nnism leading to it.  Although the exact pathophysiological \nmechanism is not completely understood yet, several re -\nsearch groups have reported increased prevalence of EP \nin women with endometriosis dealing with infertility si -\nmultaneously (15,16).  \nIt is known that adhesions associated with anatomi -\ncal disturbances are the leading mechanism resulting in \ninfertility in endometriosis patients, but the importance \nof endocrine and immunological disturbances should not \nbe neglected either, especially since the exact pathophys -\niological mechanism explaining endometriosis is so far \nnot fully understood (17). \nEndometriosis and EP are influenced by hormon -\nal changes, particularly those related to estrogen, but \nthey do so in different manners. Estrogen stimulates \nthe growth of the endometrial lining resulting in the de \nvelopment of EP, and estrogen fluctuations affect the \ngrowth of EP in a more complex manner. Estrogen recep -\ntor pattern and aromatase activity expression are altered \nin both EP and endometriosis patients, and estrogen fluc -\ntuation levels are the probable intrinsic factor linking EP, \nendometriosis and infertility (18-20). Furthermore, vas -\ncular changes associated with Endometriosis could be \n\n| 129\nReproductive challenges of endometrial polyps: the influence of women’s age and associated risk factors\nin relationship with the evolution of the EP vessel’s axis \nas well. Machado et al. have found that levels of inflam -\nmatory markers in endometrium, such as vascular endo -\nthelial growth factor (VEGF), matrix metalloproteinases \n(MMP) and angiogenesis factors 1 and 2, are higher in \npatients with EP who suffer from endometriosis at the \nsame time (21). Additionally, Wang et al. have reported \nsignificant association between endometriosis and EP in \ntheir research and emphasized that all patients dealing \nwith endometriosis should be carefully evaluated for the \nconcomitant presence of EP, regardless of the ultrasonog -\nraphy findings (22). \nUnlike EP which have a peak incidence between the \nage of 40 and 49 (23), endometriosis typically affects \nwomen during their 30s. Even though between 10 and \n15% of all women of reproductive age are affected by en -\ndometriosis, and despite all the improvements and prog -\nress in technology and diagnostics, there is still a shock -\ning average delay of nearly seven years in establishing \nendometriosis diagnosis (24). \nEstrogen levels reach their peak during women’s late \n20s. By the age of 50 there is a 50% decline in estrogen lev-\nels compared to their peak levels, with further dramatical \ndecrease during and after perimenopause (25). Endome -\ntriosis is known to be highly dependent on estrogen, but it \nis known that even if estrogen level would decline, endo -\nmetriosis symptoms would not necessarily decrease (26). \nIn this context, younger age, 35 or less, is beyond doubt \nrelated with higher estrogen levels and consequently with \nhigher endometriosis incidence, and our result supports \nthis interdependence. \nEndometriosis affects women’s quality of life in a sim -\nilar manner as Crohn’s disease, T2DM and rheumatoid \narthritis, and despite a significant percentage of women \nof reproductive age living with it, therapeutic approaches \nfor endometriosis are still limited exclusively to the man -\nagement of symptoms caused by endometriosis. In fact, \ntreatment options are oriented only to infertility or pelvic \npain treatment, without any targeted therapy designated \nfor the treatment of endometriosis (27). Endometriosis is \ndefined as an inherited, autoimmune, long-life diseases, \nwhich has to be treated from the time of diagnosis, con -\ntinuously with the individually tailored treatment ac -\ncording to patients’ overall status, age and complaints, in \norder to control the pain and further dissemination (28). \nTherefore, associations between endometriosis and EP, \nas well as the role of estrogen and its receptors, must be \ndemystified, and more comprehensive and causal treat -\nment offered to patients affected by it.   \nCONCLUSION \nThe prevalence of EPs tends to increase with advanced \nwomen’s age, a period marked by natural decline in \novarian reserve, hormonal changes and changes in en -\ndometrial health. Addressing EPs through appropriate \ndiagnostic and therapeutic measures and understanding \nthe hormonal influence on EPs and EM is crucial for im -\nproving fertility outcomes. Ongoing research and clinical \npractice must continue to focus on optimizing treatment \nstrategies to address EP pathology, ultimately supporting \nbetter reproductive outcomes for women across various \nage groups. The interplay between EPs, age and infertil -\nity underscores the importance of comprehensive repro -\nductive evaluation and tailored interventions to enhance \nfertility perspectives and support women towards their \njourney to better reproductive outcomes. \nAcknowledgement: The authors express sincere \ngratitude to the Clinical Hospital Centre “Dr Dragisa \nMisovic - Dedinje” for providing the necessary resourc -\nes and facilities, as well as to all employees working at \nthe Hospital for Gynecology and Obstetrics “Dr Dragisa \nMisovic - Dedinje”.\nFunding information:  The authors reported no \nfunding associated with the work featured in this article.\nConf lict of Interest Statement: No conflict of inter -\nest to report.\nAuthor contributions:  S. M, Lj. M, S. V, and M. H, \nconceptualization, supervision, methodology, investiga -\ntion, formal analysis, and writing—original draft; M. L, \nS. M, and Dj. K, methodology, formal analysis, visualiza -\ntion, and writing—original draft; A. S. S, K. S, and N. A, \nconceptualization, visualization, writing- original draft. \nAll authors have read and agreed to the published version \nof the manuscript.\nEthical approval:   The study was approved by the In-\nstitutional Review Board (IRB) of the University Hospi -\ntal “Dragisa Misovic” in Belgrade, Serbia, (No. 18328/4, \nDate: 29.08.2024).\nReferences \n1. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial pol -\nyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019 \nMay 2;7:2050312119848247. doi: 10.1177/2050312119848247. PMID: \n31105939; PMCID: PMC6501471. \n2. Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio Sardo A, \nCarugno J; From the Global Community of Hysteroscopy Guide -\nlines Committee. Endometrial polyps. 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Endometriosis. Nat Rev Dis Primers. 2018 Jul 19;4(1):9. doi: \n10.1038/s41572-018-0008-5. PMID: 30026507. \n28. Vujović S, Ivovic M, Tančić-Gajić M, Marina L, Ljubic A, Drago -\njević-Dikić S, Genazzani AR. Endometrium receptivity in prema -\nture ovarian insufficiency - how to improve fertility rate and pre -\ndict diseases? Gynecol Endocrinol. 2018 Dec;34(12):1011-1015. doi: \n10.1080/09513590.2018.1490715. Epub 2018 Jul 25. PMID: 30044147.\n\n| 131\nReproductive challenges of endometrial polyps: the influence of women’s age and associated risk factors\n \nREPRODUKTIVNI IZAZOVI KOD ŽENA SA ENDOMETRIJALNIM \nPOLIPIMA: UTICAJ STAROSTI I POVEZANIH FAKTORA RIZIKA\nSlađana Mihajlović1,2, Svetlana Vujović2,3, Mina Hagen4, Milan Lacković1, Sanja Milić1, Antoan Stefan Šojat 3, Kristina Saravi-\nnovska2,3, Natalija Antić3, Đurđica Kaličanin1, Ljiljana V. Marina2,3\nSažetak\nUvod / Cilј: Endometrijalni polipi (EP) predstavlјaju be-\nnigne tumore poreklom iz endometrijuma. Najčešći \nfaktori rizika koji dovode do pojave EP su hormonske \npromene povezane sa starenjem, upotreba tamoksi -\nfena, supstituciona hormonska terapija, prekomerna \ntežina i gojaznost. Tačna uzročna veza između EP-a \ni infertiliteta ostaje nejasna, ali najčešće predlagani \npatofiziološki  mehanizmi jesu mehaničke prepreke i \nbiohemijske promene na nivou endometrijalnog tki -\nva. „Zlatni standard“ dijagnostike i lečenja EP je histe -\nroskopija. Cilј ove studije je da se ispita povezanost \ngodina starosti, endometrijalnih polipa i infertiliteta.  \nMaterijal i metode: Istraživanje je obuhvatilo 301 paci-\njentkinju podvrgnutu histeroskopskoj polipektomiji radi \nlečenja infertiliteta, koje su podelјene u dve grupe na \nosnovu starosti (starost ≤ 35 i starost > 35 godina).  Po -\ndaci su prikuplјeni iz istorija bolesti i histopatoloških iz -\nveštaja, i analizirane su sledeće varijable: tip infertiliteta, \nprisustvo insulinske rezistencije, sindroma policističnih \njajnika, endometrioze, hipotireoze, prethodni neuspešni \npokušaji intrauterine inseminacije i vantelesne oplodnje \n(IVF), nepravilnosti menstrualnog ciklusa i abnormalno \nkrvarenje iz materice, veličina polipa i histopatološki tip.  \nRezultati: Najmanje jedna od pet ispitanica imala je in -\nsulinsku rezistenciju, sindrom policističnih jajnika i ab -\nnormalno krvarenje iz materice. Endometrioza, insulin -\nska rezistencija i primarni infertilitet bili su češći u mlađoj \ngrupi nego u starijoj. Prethodna istorija neuspešnih IVF \nciklusa, hipotireoza i sekundarni infertilitet bili su pove -\nzani sa uznapredovalim godinama. \nZaklјučak: Prevalencija EP ima tendenciju rasta sa godi-\nnama starosti žene, periodom koji je obeležen prirodnim \npadom rezerve jajnika, hormonskim promenama, kao i \npromenama u strukturi endometrijuma. Primena odgo -\nvarajućih dijagnostičkih i terapijskih mera, kao i razume-\nvanje uticaja godina, hormonskog statusa i povezanosti \nEP i endometrioze, klјučni su u lečenju EP , kao i u sveu -\nkupnom pobolјšanju ishoda lečenja infertiliteta.\nKljučne reči:  endometrijalni polip, infertilitet, histeroskopija\nPrimljen: 25.10.2024. I Revidiran: 04.06.2025. I Prihvaćen: 06.06.2025. I Objavljen: 30.06.2025.\nMedicinska istraživanja 2025; 58(2):125-131","source_license":"CC0","license_restricted":false}