A Systematic Review by S. Cruz, et all.
With the advent of high resolution transvaginal ultrasonography, saline-infusion ultrasonography, and hysteroscopy, the diagnosis of endometrial polyps has increased. Endometrial polyps are detected in premenopausal and postmenopausal women. Some patients are asymptomatic at the time, whereas others present with abnormal bleeding. The association between tamoxifen use and endometrial polyps suggest that estrogen stimulation of the endometrium plays an important role in the genesis of endometrial polyps. The majority of polyps are benign, but a small proportion of polyps are malignant. Polyp size does not independently predict risk of malignancy. Many studies have demonstrated that tamoxifen use increases the risk of endometrial cancer and the risk of malignancy in endometrial polyps. Obesity as assessed as an independent risk factor of malignancy within the polyps, women who are obese, have higher levels of circulating estrogen, which stimulate the endometrium to produce polyps and possibly malignant endometrial polyps. Among women with endometrial polyps, the presence of abnormal bleeding or menopausal status is associated with an increased risk of endometrial neoplasia. These finding should inform the counseling and care of women with endometrial polyps.