{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:49:32Z","timestamp":1791355772432,"version":"4.3.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometrial polyps are among the most common benign uterine lesions, yet their recurrence after hysteroscopic polypectomy remains poorly understood. Emerging evidence suggests that uterine-cavity microbial composition may be related to endometrial inflammation and tissue biology. However, the association between uterine microbiome composition and polyp recurrence has not been systematically investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a single-center retrospective cohort study of 288 women who underwent hysteroscopic polypectomy between January 2021 and June 2024. Uterine cavity fluid was collected intraoperatively for 16S rRNA amplicon sequencing (V3\u2013V4 region). Patients were classified into Lactobacillus-Dominant (LD,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f156) and Lactobacillus-Non-Dominant (LND,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f132) groups based on Lactobacillus relative abundance \u226570%. The primary outcome was endometrial polyp recurrence confirmed by hysteroscopy at 12\u202fmonths. Multivariable Cox proportional hazards regression identified independent predictors of recurrence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 12-month recurrence rate was higher in the LND group than in the LD group (31.8% vs. 14.1%,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). LND samples had higher relative abundances of Gardnerella (15.3%), Prevotella (12.1%), and Streptococcus (8.7%), higher Shannon diversity (3.87\u202f\u00b1\u202f0.98 vs. 1.34\u202f\u00b1\u202f0.52,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001), and higher serum IL-6 and CRP levels. In the multivariable Cox model, LND status remained associated with recurrence (adjusted HR 2.41; 95% CI 1.48\u20133.93;\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.001). BMI\u202f\u2265\u202f28\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , polyp size \u226515\u202fmm, multiplicity, and postoperative hormonal therapy were also associated with recurrence; the hormonal-therapy estimate indicated lower recurrence (adjusted HR 0.48). These estimates are observational and may be affected by residual confounding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Lactobacillus-non-dominant uterine-cavity microbiome status was associated with higher 12-month endometrial polyp recurrence after hysteroscopic polypectomy after adjustment for measured clinical factors. These findings support further evaluation of uterine microbiome profiles as potential risk-stratification markers, but they do not establish causality or justify routine antimicrobial or microbiome-guided treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1958046","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:16Z","timestamp":1791352216000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Uterine-cavity Lactobacillus relative abundance and endometrial polyp recurrence after hysteroscopic polypectomy: a retrospective cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Tingting","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Gynecology, Jinan Maternity and Child Care Hospital","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cenchuan","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Huai\u2019an Clinical Medical College of Jiangsu University (Huai\u2019an Hospital of Huai\u2019an City)","place":["Huai\u2019an, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, Shandong Provincial Third Hospital","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jmig.2011.09.003","article-title":"AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps","volume":"19","year":"2012","journal-title":"J Minim Invasive Gynecol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2050312119848247","DOI":"10.1177\/2050312119848247","article-title":"Endometrial polyps: pathogenesis, sequelae and treatment","volume":"7","author":"Nijkang","year":"2019","journal-title":"SAGE Open Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jmig.2011.05.018","article-title":"Diagnosis and management of endometrial polyps: a critical review of the literature","volume":"18","author":"Salim","year":"2011","journal-title":"J Minim Invasive Gynecol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0144857","DOI":"10.1371\/journal.pone.0144857","article-title":"Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy","volume":"10","author":"Yang","year":"2015","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1016\/j.jmig.2019.11.023","article-title":"Prevention of benign endometrial polyp recurrence using a levonorgestrel-releasing intrauterine system in premenopausal patients: a retrospective cohort study","volume":"27","author":"Wang","year":"2020","journal-title":"J Minim Invasive Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.fertnstert.2018.04.041","article-title":"Relevance of assessing the uterine microbiota in infertility","volume":"110","author":"Moreno","year":"2018","journal-title":"Fertil Steril"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1038\/s41467-017-00901-0","article-title":"The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases","volume":"8","author":"Chen","year":"2017","journal-title":"Nat Commun"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.ajog.2016.09.075","article-title":"Evidence that the endometrial microbiota has an effect on implantation success or failure","volume":"215","author":"Moreno","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"ref9","first-page":"1581","article-title":"Barcoded sequencing reveals diverse intrauterine microbiomes in patients suffering with endometrial polyps","volume":"8","author":"Fang","year":"2016","journal-title":"Am J Transl Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1351329","DOI":"10.3389\/fcimb.2024.1351329","article-title":"Endometrial microbiota alteration in female patients with endometrial polyps based on 16S rRNA gene sequencing analysis","volume":"14","author":"Zhao","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"R81","DOI":"10.1530\/REP-21-0120","article-title":"Current findings in endometrial microbiome: impact on uterine diseases","volume":"163","author":"Medina-Bastidas","year":"2022","journal-title":"Reproduction"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1055\/s-0043-1777361","article-title":"Uterine microbiome: does the sampling technique matter?","volume":"41","author":"L\u00fcll","year":"2023","journal-title":"Semin Reprod Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.tim.2018.11.003","article-title":"Contamination in low microbial biomass microbiome studies: issues and recommendations","volume":"27","author":"Eisenhofer","year":"2019","journal-title":"Trends Microbiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1038\/s41564-025-02035-2","article-title":"Guidelines for preventing and reporting contamination in low-biomass microbiome studies","volume":"10","author":"Fierer","year":"2025","journal-title":"Nat Microbiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.fertnstert.2017.05.016","article-title":"Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link","volume":"108","author":"Cicinelli","year":"2017","journal-title":"Fertil Steril"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1016\/j.fertnstert.2007.03.074","article-title":"Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies","volume":"89","author":"Cicinelli","year":"2008","journal-title":"Fertil Steril"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1111\/jog.13937","article-title":"Review: chronic endometritis and its effect on reproduction","volume":"45","author":"Kimura","year":"2019","journal-title":"J Obstet Gynaecol Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1152\/physrev.00031.2019","article-title":"Physiology of the endometrium and regulation of menstruation","volume":"100","author":"Critchley","year":"2020","journal-title":"Physiol Rev"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"378","DOI":"10.3389\/fimmu.2020.00378","article-title":"The interplay between reproductive tract microbiota and immunological system in human reproduction","volume":"11","author":"Al-Nasiry","year":"2020","journal-title":"Front Immunol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.3389\/fmed.2018.00181","article-title":"The vaginal microenvironment: the physiologic role of lactobacilli","volume":"5","author":"Amabebe","year":"2018","journal-title":"Front Med (Lausanne)"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/s13073-016-0368-y","article-title":"Potential contribution of the uterine microbiome in the development of endometrial cancer","volume":"8","author":"Walther-Ant\u00f3nio","year":"2016","journal-title":"Genome Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s10815-015-0614-z","article-title":"Endometrial microbiome at the time of embryo transfer: next-generation sequencing of the 16S ribosomal subunit","volume":"33","author":"Franasiak","year":"2016","journal-title":"J Assist Reprod Genet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12905-023-02232-3","article-title":"Chronic endometritis increases the recurrence of endometrial polyps in premenopausal women after hysteroscopic polypectomy","volume":"23","author":"Qu","year":"2023","journal-title":"BMC Womens Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jmig.2006.07.008","article-title":"Polypectomy in premenopausal women with abnormal uterine bleeding: effectiveness of hysteroscopic removal","volume":"14","author":"Henriquez","year":"2007","journal-title":"J Minim Invasive Gynecol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.jmig.2009.04.005","article-title":"Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: cross-sectional study","volume":"16","author":"Lieng","year":"2009","journal-title":"J Minim Invasive Gynecol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1958046\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:17Z","timestamp":1791352217000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1958046\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":25,"alternative-id":["10.3389\/fpubh.2026.1958046"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1958046","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1958046"}}