Does the presence of single compared to multiple endometrial polyps alter the risk of cancer in post-menopausal women?

Published:October 27, 2022DOI:



      To evaluate the relative rates of malignancy in women with single and multiple polyps presenting to a UK Cancer Centre with postmenopausal bleeding (PMB).

      Study Design

      A retrospective review of patients treated at Royal Derby Hospital (RDH) for PMB who underwent outpatient hysteroscopy based on ultrasonographic suspicion of endometrial polyps between May 2014 to December 2019. The main outcome measure was the rates of precancerous and malignant histology for single or multiple polyps. The secondary outcomes assessed the influence of risk factors on the rates of malignancy within the single and multiple polyps groups.


      The study population was 851 women of which 533 were in the single polyp group and 318 in the multiple polyps group. The multiple polyps group (mean age 65.2 years) was older compared to the single polyp group (mean age 62.1 years), P = 0.0001. Elevated rates of cancer was driven most significantly by endometrioid cancer in the multiple polyps compared to single polyp group, with rates of 50/314 (16 %) and 28/512 (5.5 %) respectively, P=< 0.00001. For rarer histologies there was no significant difference between the proportion of serous, carcinosarcomas and clear cell cancers between those with single compared to multiple polyps (P > 0.05). Significantly more endometrial hyperplasia with atypia (AEH) was found in the multiple polyps compared to single polyp group, with rates of 18/314 (5.7 %) and 15/512 (2.9 %) respectively, P = 0.046.


      Our study found increased rates of endometrioid cancer and its precursor, AEH within the multiple polyps compared to the single polyps groups. Future risk predicting algorithms should consider incorporating single and multiple polyps as part of their risk model.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      1. Cancer Research UK. Uterine cancer statistics [Internet]. 2021 [cited 2022 Jan 9]. Available from:

        • Jones E.R.
        • O’Flynn H.
        • Njoku K.
        • Crosbie E.J.
        Detecting endometrial cancer.
        Obstet Gynaecol. 2021; 23: 103-112
      2. BGCS. BGCS Uterine Cancer Guidelines: Recommendations for Practice [Internet]. 2021 [cited 2022 Apr 23]. Available from:

        • Dreisler E.
        • Stampe Sorensen S.
        • Ibsen P.H.
        • Lose G.
        Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20–74 years.
        Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2009 Jan; 33: 102-108
        • Anastasiadis P.G.
        • Koutlaki N.G.
        • Skaphida P.G.
        • Galazios G.C.
        • Tsikouras P.N.
        • Liberis V.A.
        Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding.
        Eur J Gynaecol Oncol. 2000; 21: 180-183
        • Domingues A.P.
        • Lopes H.
        • Dias I.
        • De Oliveira C.F.
        Endometrial polyps in postmenopausal women.
        Acta Obstet Gynecol Scand. 2009; 88: 618-620
        • Oguz S.
        • Sargin A.
        • Kelekci S.
        • Aytan H.
        • Tapisiz O.L.
        • Mollamahmutoglu L.
        The role of hormone replacement therapy in endometrial polyp formation.
        Maturitas. 2005 Mar 14; 50: 231-236
        • Tang Z.
        • Zhou R.
        • Bao D.
        • Liu C.
        • Wei L.
        Clinical characteristics of 42 cases of malignant endometrial polyps.
        Zhonghua Fu Chan Ke Za Zhi. 2014 Mar; 49: 204-207
      3. Pandey J, Yonder S. Premalignant Lesions Of The Endometrium. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.

        • DiSaia P.
        • et al.
        Clinical Gynecologic Oncology.
        9th Edition. Elsevier, 2017
        • van Hanegem N.
        • Breijer M.C.
        • Slockers S.A.
        • Zafarmand M.H.
        • Geomini P.
        • Catshoek R.
        • et al.
        Diagnostic workup for postmenopausal bleeding: a randomised controlled trial.
        BJOG Int J Obstet Gynaecol. 2017 Jan; 124: 231-240
      4. NHS England. Faster Diagnosis [Internet]. [cited 2022 Apr 24]. Available from:

        • Burbos N.
        • Musonda P.
        • Giarenis I.
        • Shiner A.M.
        • Giamougiannis P.
        • Morris E.P.
        • et al.
        Predicting the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding: the Norwich DEFAB risk assessment tool.
        Br J Cancer. 2010 Apr 13; 102: 1201-1206
        • Shor S.
        • Pansky M.
        • Maymon R.
        • Vaknin Z.
        • Smorgick N.
        Prediction of premalignant and malignant endometrial polyps by clinical and hysteroscopic features.
        J Minim Invasive Gynecol. 2019 Dec; 26: 1311-1315
        • Fernández-Parra J.
        • Rodríguez Oliver A.
        • López Criado S.
        • Parrilla Fernández F.
        • Montoya V.F.
        Hysteroscopic evaluation of endometrial polyps.
        Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2006 Nov; 95: 144-148
        • Elfayomy A.K.
        • Soliman B.S.
        Risk factors associated with the malignant changes of symptomatic and asymptomatic endometrial polyps in premenopausal Women.
        J Obstet Gynaecol India. 2015 May; 65: 186-192
      5. RCOG. Best Practice in Outpatient Hysteroscopy [Internet]. RCOG; 2011 [cited 2022 Jan 10]. (Green Top Guideline No. 59). Available from:

        • Annan J.J.
        • Aquilina J.
        • Ball E.
        The management of endometrial polyps in the 21st century.
        Obstet Gynaecol. 2012 Jan 1; 14: 33-38
      6. NICE. Menopause: diagnosis and management [Internet]. 2015 [cited 2022 Jun 4]. Available from:

        • Kandoth C.
        • Schultz N.
        • Cherniack A.D.
        • Akbani R.
        • Liu Y.
        • Shen H.
        • et al.
        Integrated genomic characterization of endometrial carcinoma.
        Nature. 2013 May 2; 497: 67-73
        • Rakha E.
        • Wong S.C.
        • Soomro I.
        • Chaudry Z.
        • Sharma A.
        • Deen S.
        • et al.
        Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature.
        Am J Surg Pathol. 2012 Nov; 36: 1683-1690
        • Doherty M.T.
        • Sanni O.B.
        • Coleman H.G.
        • Cardwell C.R.
        • McCluggage W.G.
        • Quinn D.
        • et al.
        Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis.
        PLoS ONE. 2020; 15: e0232231
        • Ghoubara A.
        • Sundar S.
        • Ewies A.A.A.
        Predictors of malignancy in endometrial polyps: study of 421 women with postmenopausal bleeding.
        Climacteric J Int Menopause Soc. 2018 Feb; 21: 82-87
      7. NICE. Testing strategies for Lynch syndrome in people with endometrial cancer [Internet]. 2020 [cited 2022 Jun 4]. Available from: