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

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.

Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment

“…Recent studies and review showed increased risk of EP in women suffering from chronic endometritis [24]. This data supports a potential inflammatory origin for some kinds of EP [25].…”

Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome—A Systematic Review and Meta-Analysis

“…On the one hand, such a reaction may disrupt the embryo–endometrial crosstalk and hamper the process of blastocyst invasion [ 14 ]. On the other hand, sustained up-regulation of proliferative genes and down-regulation of apoptotic genes [ 18 ] (required for endometrial reaction) may promote the development of proliferative lesions such as (micro and macro) polyps [ 18 , 38 , 39 ]. Moreover, significant and severe alterations in the vascularization and decidualization of secretory endometrium [ 6 , 40 ] may further contribute to receptivity impairment in CE.…”

Text mining in a literature review of abnormal uterine bleeding according to the FIGO classification

“…In addition, chronic inflammation in the uterus, including chronic endometritis, is also involved in the development of endometrial polyps, and this complex causes endometrial polyps. [16][17][18] AUB-A can occur with or without dysmenorrhea. 19,20 We discovered that AUB-A was linked to HMB and was commonly treated with endometrial ablation (Figure 5).…”