OBJECTIVE: This retrospective study investigated the prognostic significance and risk factors of benign pathologic types of background endometrium surrounding endometrial polyps (EPs). METHODS: We assessed 206 patients who underwent hysteroscopic polypectomy and background endometrium biopsy. Patients were categorized into four groups based on the pathologic types of background endometrium: normal proliferative endometrium (NPE), polypoid hyperplastic endometrium (PHE), chronic endometritis (CE), and non-atypical endometrial hyperplasia (NEH). We employed univariable comparisons and multivariable logistic regression analysis to identify risk factors of PHE, CE, and NEH compared to NPE. Abnormal uterine bleeding (AUB) and recurrence of EPs were monitored over a 12-month postoperative follow-up period. RESULTS: Independent risk factors for EPs with a background of CE included a history of genital tract infection (OR = 8.88, 95% CI: 2.95-26.70, P = 0.000), adenomyosis (OR = 13.70, 95% CI: 3.38-55.52, P = 0.000), and hydrosalpinx (OR = 2.23, 95% CI: 1.59-54.09, P = 0.013). Age (OR = 1.18, 95% CI: 1.07-1.30, P = 0.001) and BMI (OR = 1.33, 95% CI: 1.11-1.61, P = 0.003) were significant risk factors for EPs with a background of NEH. Patients with PHE had higher recurrence rates of EPs following 12 months of follow-up. Moreover, background endometrium types PHE, CE, and NEH were associated with poorer control of AUB. CONCLUSION: Our study underscores the importance of examining the histopathologic characteristics of the background endometrium surrounding EPs, as these benign lesions significantly influence the recurrence and symptomatology of EPs.