Endometrial hyperplastic changes as an independent predictor of recurrence after hysteroscopic polypectomy: a retrospective cohort study.

ObjectiveTo identify risk factors for recurrence after hysteroscopic endometrial polypectomy, with particular emphasis on postoperative pathological features (endometrial hyperplastic changes) and potential protective role of medical therapy using progestins.MethodsThis retrospective cohort study included 145 patients who underwent hysteroscopic polypectomy at XianJu People's Hospital from January 2020 to December 2023. Data on demographics, polyp characteristics (number, size), postoperative pathology (presence of hyperplastic changes), and postoperative progestin therapy were collected. The primary outcome was polyp recurrence, defined as a new lesion confirmed by ultrasound or hysteroscopy at least six months after surgery. Survival analysis using the Kaplan-Meier method and Cox proportional hazards regression were performed to screen for independent risk factors.ResultsThe mean follow-up time was 24.28 months. Recurrence occurred in 57 of 145 patients (39.3%). Multivariate Cox regression analysis identified endometrial hyperplastic changes as a significant independent risk factor for recurrence (HR = 2.016, 95% CI: 1.199-3.389, P = 0.008). Postoperative progestin therapy was associated with a 37% reduction in recurrence risk, although this did not reach statistical significance (HR = 0.626, 95% CI: 0.364-1.076, P = 0.090).ConclusionEndometrial hyperplastic changes in postoperative pathology are a key independent predictor of polyp recurrence after hysteroscopic polypectomy, nearly doubling the risk. While progestin therapy did not show a statistically significant protective effect, the observed trend toward risk reduction is clinically meaningful. Postoperative pathological findings should be used for risk stratification, and intensified follow-up should be considered for high-risk patients.