Chronic endometritis and endometriosis: is there an interrelationship?

Authors

  • N.Y. Pedachenko Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine, Ukraine
  • R.A. Tukhtarian Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine, Ukraine
  • I.L. Avetis'yan Kiev City Clinical Endocrinology Center, Kyiv, Ukraine, Ukraine
  • T.L. Shemelko Precarpathian Center for Human Reproduction, Ministry of Health of Ukraine, Ivano-Frankivsk, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2306-2436.10.3.2021.246349

Keywords:

endometriosis, adenomyosis, chronic endometritis, CD 138, review

Abstract

Background. Chronic endometritis and endometriosis have a lot in common. Both diseases are long-term inflammatory processes, with definitively unspecified etiological factors and pathogenetic mechanisms that negatively affect fertility and may cause pelvic pain or abnormal uterine bleeding. The issue of effective and timely diagnosis of chronic endometritis remains open due to the lack of specific clinical symptoms and clinical examination data. Assessment of current scientific evidence of the interrelationship between endometriosis and chronic endometritis. Materials and methods. A systematic search of scientific medical information has been conducted in English-language databases: MEDLINE, Scopus, Web of Science, Medline, The Cochrane Library, PubMed. Results. According to the review of various scientific studies that have recently been conducted, it has been found that patients with endometriosis statistically have a significantly higher risk of developing chronic endometritis by 1.3-2.5 times than women without endometriosis. Using a histological endometrial study and detection of CD138, chronic endometritis was found in 52.94 % of women in the endometriosis group and in 27.02 % of patients in the endometriosis-free group; the rate was significantly higher in the endometriosis group than in the control group (p = 0.0311). Moreover, 76% of women with endometriosis showed inflammatory processes of pelvic organs (compared to the control group, where inflammation was found in 38.4 % of women, p < 0.0001). Conclusions. Patients with endometritis demonstrate a positive correlation with development of endometriosis. Given the inability to establish a causal relationship between endometriosis and chronic endometritis, extended diagnosis is necessary to eliminate chronic endometritis, especially if women have abnormal uterine bleeding or chronic pelvic pain. The combination of histological and immunohistochemical endometrial examination methods has shown its effectiveness in timely diagnosis of chronic endometritis. Identifying and adequately treating this condition will help avoid unnecessary surgery.

References

Денисова Т. Г., ред. Генитальный эндометриоз: текст лекций. Чебоксары: Ин-т усовершенствования врачей; 2015. 51 с.

Ярмолинская М. И. Наружный генитальный эндометриоз и бесплодие: учеб. пособие. СПб.: Изд-во СЗГМУ им. И. И. Мечникова; 2013. 62 с.

Pezzolla A., Lattarulo S., Fiore M.G., Piscitelli D., Fabiano G., Palasciano N. Extra-genital endometriosis. Ann Ital Chir. 2014 Jul-Aug;85(4):341-6.

Veeraswamy A., Lewis M., Mann A., Kotikela S., Hajhosseini B., Nezhat C. Extragenital endometriosis. Clin Obstet Gynecol. 2010 Jun;53(2):449-66. doi: 10.1097/GRF.0b013e3181e0ea6e.

Peiris A.N., Chaljub E., Medlock D. Endometriosis. JAMA. 2018 Dec 25;320(24):2608. doi: 10.1001/jama.2018.17953.

Maindiratta B., Lim B.H. Pregnancy after endometriosis: a new challenge? BJOG. 2017 Feb;124(3):452. doi: 10.1111/1471-0528.13979.

Macer M.L., Taylor H.S. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012 Dec;39(4):535-49. doi: 10.1016/j.ogc.2012.10.002.

Begum T., Chowdhury S.R. Aetiology and pathogenesis of endometriosis - a review. Mymensingh Med J. 2013 Jan;22(1):218-21.

Кононов А.В., Мозговой С.И., Мозговая Е.И., Новиков Д.Г. Эндометриоз: теории происхождения. Омск. науч. вестн. 2008;(1):32-6.

Koch J., Rowan K., Rombauts L., Yazdani A., Chapman M., Johnson N. Endometriosis and infertility - a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence). Aust N Z J Obstet Gynaecol. 2012 Dec;52(6):513-22. doi: 10.1111/j.1479-828X.2012.01480.x.

Sourial S., Tempest N., Hapangama D.K. Theories on the pathogenesis of endometriosis. Int J Reprod Med. 2014;2014:179515. doi: 10.1155/2014/179515.

Takebayashi A., Kimura F., Kishi Y., Ishida M., Takahashi A., Yamanaka A., Takahashi K., Suginami H., Murakami T. The association between endometriosis and chronic endometritis. PLoS One. 2014 Feb 18;9(2):e88354. doi: 10.1371/journal.pone.0088354. PMID: 24558386; PMCID: PMC3928198.

Maybin J.A., Critchley H.O., Jabbour H.N. Inflammatory pathways in endometrial disorders. Mol.Cell. Endocrinol. 2011; 15 (335): 42-51.

Robker R.L., Wu L.L., Yang X. Inflammatory pathways linking obesity and ovarian dysfunction. J Reprod Immunol. 2011;88(2):142–8.

Кобаидзе Е.Г., Падруль М.М. Высокие риски соматической патологии у женщин с хроническим эндометритом. Анализ риска здоровью. 2017; 4:57-65. DOI: 10.21668/health.risk/2017.4.06

Ovcharuk E.A., Khadartseva K.A., Ovcharuk V.L. Autoimmune chronic endometritis: diagnostics and treatment. Vestnik novykh meditsinskikh tekhnologii. 2013;1:221. (In Russ.)]

Wu D., Kimura F., Zheng L., Ishida M., Niwa Y., Hirata K., Takebayashi A., Takashima A., Takahashi K., Kushima R., Zhang G., Murakami T. Chronic endometritis modifies decidualization in human endometrial stromal cells. Reprod Biol Endocrinol. 2017 Mar 4;15(1):16. doi: 10.1186/s12958-017-0233-x. PMID: 28259137; PMCID: PMC5336610.

Cicinelli E., Vitagliano A., Loizzi V., De Ziegler D., Fanelli M., Bettocchi S., Nardelli C., Trojano G., Cicinelli R., Minervini C.F., Leronni D., Viggiano L. Altered Gene Expression Encoding Cytochines, Grow Factors and Cell Cycle Regulators in the Endometrium of Women with Chronic Endometritis. Diagnostics (Basel). 2021 Mar 8;11(3):471. doi: 10.3390/diagnostics11030471. PMID: 33800186; PMCID: PMC7999985.

Margulies S.L., Flores V., Parkash V., Pal L. Chronic endometritis: A prevalent yet poorly understood entity. Int J Gynaecol Obstet. 2021 Oct 4. doi: 10.1002/ijgo.13962. Epub ahead of print. PMID: 34605024.

Шурпяк С.О. Оцінка коморбідності в менеджменті пацієнток з дисгормональною доброякісною поєднаною проліферативною патологією репродктивних органів. Збірник наукових праць Асоціації акушерів-гінекологів України. 2018; 1 (39): 94-98.

Leyendecker G., Bilgicyildirim A., Inacker M., Stalf T., Huppert P. [et al.]. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol Obstet. 2015; 291: 917-32.

Taran F.A., Stewart E.A., Brucker S. Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives tohysterectomy. Geburtshilfe Frauenheilkd. 2013;73:924-31.

Van Weel C., Schellevis F.G. Comorbidity and guidelines: conflicting interests. Lancet. 2006; 367: 550-551.

Масякина А.В., Кудрина Е.А. Диагностика и лечениедоброкачественных гиперпластических заболеваний матки у женщин с эндокринно-обменными нарушениями. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2015; 3: 20-24.

Eun Ji Choi, Seong Beom Cho, Sa Ra Lee, Young Mi Lim [et al.]. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci. 2017; 60(6):579-586. https://doi.org/10.5468/ ogs.2017.60.6.579

Teng S.W., Horng H.C., Ho C.H., Yen M.S., Chao H.T., Wang P.H. [et al.]. Women with endometriosis have higher comorbidities: analysis of domestic data in Taiwan. J Chin Med Assoc. 2016;79:577-82.

Nezhat C., Li A., Abed S., Balassiano E., Soliemannjad R., Nezhat A. [et 350 al.]. Strong association between endometriosis and symptomatic leiomyomas. JSLS. 2016; 20:e2016.00053.

Teng S.W., Horng H.C., Ho C.H., Yen M.S., Chao H.T., Wang P.H. [et al.]. Women with endometriosis have higher comorbidities: analysis of domestic data in Taiwan. J Chin Med Assoc. 2016;79:577-82.

Lin K.Y., Chang C.Y., Lin W.C,. Wan L. Increased risk of endometriosis in patients with endometritis - a nationwide cohort study involving 84,150 individuals. Ginekol Pol. 2020;91(4):193-200. doi: 10.5603/GP.2020.0040. PMID: 32374019.

Kao L.C., Germeyer A., Tulac S., et al. Expression profiling of endometrium from women with endometriosis reveals candidate genes for disease-based implantation failure and infertility. Endocrinology. 2003; 144(7): 2870–2881, doi: 10.1210/en.2003-0043, indexed in Pubmed: 12810542.

Tao Yu., Zhang Q., Huang W., et al. The peritoneal leptin, MCP-1 and TNF-α in the pathogenesis of endometriosis-associated infertility. Am J Reprod Immunol. 2011; 65(4): 403–406, doi: 10.1111/j.1600-0897.2010.00920.x, indexed in Pubmed: 20825374.

Lebovic D.I., Mueller M.D., Taylor R.N. Immunobiology of endometriosis. Fertil Steril. 2001; 75(1): 1–10, doi: 10.1016/s0015-0282(00)01630-7, indexed in Pubmed: 11163805.

Bedaiwy M.A., Falcone T. Peritoneal fluid environment in endometriosis. Clinicopathological implications. Minerva Ginecol. 2003; 55(4): 333–345, indexed in Pubmed: 14581858.

Missmer S.A., Cramer D.W., Cramer D.W., et al. The epidemiology of endometriosis. Ann N Y Acad Sci. 2002; 955(1): 11–22; discussion 34, doi: 10.1111/j.1749-6632.2002.tb02761.x, indexed in Pubmed: 11949940.

Lin W.C., Chang CYY, Hsu Y.A., et al. Increased Risk of Endometriosisin Patients With Lower Genital Tract Infection: A Nationwide Cohort Study. Medicine (Baltimore). 2016; 95(10): e2773, doi: 10.1097/MD.0000000000002773, indexed in Pubmed: 26962775.

Cicinelli E., De Ziegler D., Nicoletti R., et al. Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. Gynecol Obstet Invest. 2009; 68(2): 108–115, doi: 10.1159/000223819, indexed in Pubmed: 19521097.

Kitaya K., Matsubayashi H., Takaya Y., et al. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. Am J Reprod Immunol. 2017; 78(5), doi: 10.1111/aji.12719, indexed in Pubmed: 28608596.

Freitag N., Pour S.J., Fehm T.N., Toth B., Mar­kert U.R., Weber M., Togawa R., Kruessel J.S., Baston-Buest D.M., Bielfeld A.P. Are uterine natural killer and plasma cells in infertility patients associated with endometriosis, repeated implantation failure, or recurrent pregnancy loss? Arch Gynecol Obstet. 2020 Dec;302(6):1487-1494. doi: 10.1007/s00404-020-05679-z. Epub 2020

Kitaya K., Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immunol. 2011 Nov;66(5):410-5. doi: 10.1111/j.1600-0897.2011.01051.x. Epub 2011 Jul 12. PMID: 21749546.

Bayer-Garner I.B., Korourian S. (2001) Plasma cells in chronic endometritis are easily identified when stained with syndecan-1. Mod Pathol 14: 877–879.

Pikarsky E., Porat R.M., Stein I., Abramovitch R., Amit S., et al. (2004) NF-kappaB functions as a tumour promoter in inflammation-associated cancer. Nature 431: 461–466.

Greten F.R., Karin M. (2004) The IKK/NF-kappaB activation pathway-a target for prevention and treatment of cancer. Cancer Lett 206: 193–199.

Cicinelli E., Trojano G., Mastromauro M., Vimercati A., Marinaccio M., Mitola P.C., Resta L., de Ziegler D. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. Fertil Steril. 2017 Aug;108(2):289-295.e1. doi: 10.1016/j.fertnstert.2017.05.016. Epub 2017 Jun 16. PMID: 28624114.

Cicinelli E. Tinelli R. Lepera A. Pinto V. Fucci M. Resta L. Correspondence between hysteroscopic and histologic findings in women with chronic endometritis. Acta Obstet Gynecol Scand. 2010; 89: 1061-1065

Published

2021-12-16

Issue

Section

Medicine