Association between Endometrial Polyps and Chronic Endometritis: Is It Time for a  Paradigm Shift in the Pathophysiology of Endometrial Polyps in Pre-Menopausal  Women? Results of a Systematic Review and Meta-Analysis

Amerigo Vitagliano; Mariangela Cialdella; Rossana Cicinelli; Carla Mariaflavia Santarsiero; Pantaleo Greco; Giovanni Buzzaccarini; Marco Noventa; Ettore Cicinelli

doi:10.3390/diagnostics11122182

Uterine and Pelvic Conditions Acquired Uterine Conditions

Association between Endometrial Polyps and Chronic Endometritis: Is It Time for a Paradigm Shift in the Pathophysiology of Endometrial Polyps in Pre-Menopausal Women? Results of a Systematic Review and Meta-Analysis

Vitagliano A, Cialdella M, Cicinelli R, Santarsiero CM, Greco P, Buzzaccarini G, Noventa M, Cicinelli E

Published November 24, 2021 Diagnostics (Basel, Switzerland), 11(12), 2182

DOI 10.3390/diagnostics11122182 PMID 34943419 PMC PMC8700534

RRM Academy Synopsis

Endometrial polyps are linked to chronic endometritis before menopause

A meta-analysis studied 3,225 women before menopause. Women with endometrial polyps had about three times the odds of chronic endometritis than women without polyps. In seven pooled studies, about 5 out of 10 women with polyps also had chronic endometritis.

Key Findings

Seven studies of 1,248 patients with polyps gave a pooled chronic endometritis prevalence of 51.35% (95% CI, 27.24%–75.13%), ranging from 28.71% to 92.59% across studies.
Three studies of 872 women (483 with polyps, 389 with a non-polypoid endometrium) found higher odds of chronic endometritis with polyps: OR 3.07, 95% CI 1.59–5.95.
In three studies of 349 polyps, the pooled proportion of CD-138-positive polyps was 70.73% (95% CI, 55.73–83.68%). CD-138 staining marks the plasma cells used to diagnose chronic endometritis.
One study of 174 women found higher odds of chronic endometritis with multiple polyps (92 women) than with a single polyp (82 women): OR 3.43, 95% CI 1.83–6.46.

Interpretation

This review pooled eight observational studies of women before menopause. Each woman had a hysteroscopy for infertility, repeated miscarriage, abnormal bleeding, or another reason. Across these studies, endometrial polyps and chronic endometritis were linked. The authors say the two conditions may be steps in one disease process. They note that studies used different plasma cell counts to define chronic endometritis, which limits how precise the prevalence estimate is. The findings support larger studies of this link.

RRM Context

The authors say chronic endometritis may impair the lining's receptivity, with unexplained infertility as one result. Restorative reproductive medicine treats that infertility as undiagnosed. A link between the two puts polyps in the search for a cause.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Chronic endometritis (CE) and endometrial polyps (EPs) are common conditions in reproductive age women. CE is an infectious disorder of the endometrium characterized by signs of chronic inflammation at hysteroscopic and histological analyses. EPs are abnormal endometrial growths containing glands, stroma and blood vessels projecting from the lining of the uterus. During the last years, different authors have investigated the correlation between CE and EPs, with controversial results. The aim of this study was to summarize available evidence on the potential correlation between CE and EPs.

Design

Systematic literature review and meta-analysis.

Methods

Observational-studies were identified by searching electronic databases from their inception to September 2021. Only studies on pre-menopausal women were included. Statistical analysis was performed using MedCalc 16.4.3 (Ostend, Belgium) and Review Manager version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). The summary measures were reported as pooled proportion or odds ratio (OR) with 95% confidence interval (CI). The primary outcome was to evaluate the prevalence of CE in women with EPs. The secondary outcome was to determine the prevalence of CD-138-positive EPs among EPs. Tertiary outcomes were to compare the prevalence of CE in women with EPs versus women with a non-polypoid endometrium and to compare the prevalence of CE in women with a single EP versus women with multiple EPs.

Results

Eight observational studies (n = 3225 patients) were included in quantitative synthesis. Pooled prevalence of CE among women with EPs was 51.35% (95% CI, 27.24-75.13%). Pooled proportion of CD-138-positive EPs among EPs was 70.73% (95% CI, 55.73-83.68%). Women with EPs showed higher prevalence of CE compared to women without EPs (OR 3.07, 95% CI 1.59-5.95). Women with ≥3 EPs had higher prevalence of CE then women with a single EP (OR 3.43, 95% CI 1.83-6.46).

Conclusions

In pre-menopausal women, CE and EPs may have a dependent relationship and may represent two consequent steps of a common pathological process.

Read the guide

Chronic Endometritis: The Missed Diagnosis Behind Recurrent Miscarriage and Failed Implantation

Topics

Uterine and Pelvic Conditions › Acquired Uterine Conditions › Endometrial Polyps · General Gynecology › Infections › Pelvic Inflammatory Disease · Infections and the Reproductive Microbiome › Chronic Endometritis › Diagnosis of Chronic Endometritis

Amerigo Vitagliano, Mariangela Cialdella, Rossana Cicinelli, Carla Mariaflavia Santarsiero, Pantaleo Greco, Giovanni Buzzaccarini, Marco Noventa, Ettore Cicinelli

A Vitagliano, M Cialdella, R Cicinelli, C Santarsiero, P Greco, G Buzzaccarini, M Noventa, E Cicinelli

PMID 34943419 34943419 DOI 10.3390/diagnostics11122182 10.3390/diagnostics11122182 Vitagliano et al. 2021, Vitagliano 2021