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General Gynecology · Infections

The association between endometriosis and chronic endometritis

Takebayashi A, Kimura F, Kishi Y, Ishida M, Takahashi A, Yamanaka A, Takahashi K, Suginami H, Murakami T

Published February 22, 2014 PloS One, 9(2), e88354
DOI 10.1371/journal.pone.0088354 PMID 24558386 PMC PMC3928198

RRM Academy Synopsis

Chronic endometritis was more common in women with endometriosis

Chronic endometritis was found in about 5 out of 10 women with endometriosis and about 3 out of 10 without it. The comparison used tissue from 71 women who had a hysterectomy at two hospitals in Japan. Only endometriosis was linked to chronic endometritis among the factors analyzed.

Key Findings

  • Chronic endometritis, a persistent inflammation of the uterine lining, was found in 52.94% (18 of 34) of the endometriosis group and 27.02% (10 of 37) of the non-endometriosis group (p = 0.0311).
  • A stepwise logistic regression including age, BMI, number of pregnancies, parity, leiomyoma and adenomyosis found only endometriosis related to chronic endometritis (odds ratio 3.037, 95% CI 1.129–8.174; p = 0.028).
  • Stage III endometriosis had the highest rate (70.0%, 7 of 10); stages I, II and IV had 40.0%, 50.0% and 46.7%, and early and late stages did not differ significantly.
  • More than 11 plasma cells in one high-powered field occurred in 17.65% of the endometriosis group and 0% of the non-endometriosis group (p = 0.0094).
  • Among women with endometriosis, 12 of 23 (52.2%) with ovarian endometrioma and 6 of 11 (54.5%) without had chronic endometritis, with no significant difference between these two groups.

Interpretation

The authors compared tissue from 34 women with endometriosis and 37 without, all taken at hysterectomy, and they report an association. Women who used suppressive hormonal medications, including oral contraceptives, before surgery were excluded. The endometriosis group had more adenomyosis and less leiomyoma. The authors list hysterectomy samples as a limitation. They write that the cause of the chronic endometritis remains unclear and may be an infection or the endometriosis itself.

RRM Context

The paper cites earlier reports of chronic endometritis in 12–46% of infertile patients and 28% of unexplained infertility. The condition usually causes few or no symptoms, so RRM, which treats unexplained infertility as undiagnosed, looks for it.

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

Abstract

Objective

To evaluate the association between endometriosis and chronic endometritis.

Methods

Endometrial specimens were obtained from 71 patients, 34 with endometriosis (endometriosis group) and 37 without endometriosis (non-endometriosis group), who underwent hysterectomy, and the specimens were immunostained for the plasmacyte marker CD138. The rate of chronic endometritis was compared between the endometriosis group and the non-endometriosis group. Furthermore, the 71 patients were also divided into two groups, 28 with chronic endometritis (chronic endometritis group) and 43 without chronic endometritis (non-chronic endometritis group). Logistic regression analysis was performed with variables including age, body mass index (BMI), gravidity and parity, and diagnoses of leiomyoma, adenomyosis, and endometriosis on pathology to examine the independent effect of each variable on chronic endometritis. Patients suffering from cervical invasive carcinoma, endometrial carcinoma, and endometrial polyps or treated with gonadotropin-releasing hormone agonists, progestins, or oral contraceptives before surgery were excluded.

Results

Chronic endometritis was identified in 52.94% of the endometriosis group and 27.02% of the non-endometriosis group (p<0.05). Logistic regression analysis revealed that endometriosis was associated with chronic endometritis.

Conclusions

This result suggests a strong association between endometriosis and chronic endometritis.

Topics

By this author

Related research

General Gynecology › Infections › Pelvic Inflammatory Disease · Infections and the Reproductive Microbiome › Chronic Endometritis › Diagnosis of Chronic Endometritis · Diagnostics › Endometrial Assessment › Endometrial Infection
Akie Takebayashi, Fuminori Kimura, Yohei Kishi, Mitsuaki Ishida, Akimasa Takahashi, Akiyoshi Yamanaka, Kentaro Takahashi, Hiroshi Suginami, Takashi Murakami
A Takebayashi, F Kimura, Y Kishi, M Ishida, A Takahashi, A Yamanaka, K Takahashi, H Suginami, T Murakami
PMID 24558386 24558386 DOI 10.1371/journal.pone.0088354 10.1371/journal.pone.0088354 Takebayashi et al. 2014, Takebayashi 2014

Keywords

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