Current global trends in the study of etiology, pathogenesis, diagnosis and treatment of chronic endometritis

Abstract

The article is devoted to the analysis of scientific information on the problem of chronic endometritis (CE) today. CE is a mysterious, multifactorial disease, the etiology, pathogenesis, and optimal treatment of which have not yet been definitively determined.Endometrial inflammation is a complex part of its physiology that is finely regulated by the balance between pro- and anti-inflammatory mechanisms and is involved in all reproductive events.Chronic inflammation stimulates hormone-independent cell proliferation, suppression of apoptosis processes, activation of tumor growth factors, invasion, tumor angiogenesis, and neovasculogenesis. The transformation of the inflammatory process occurs due to chronic leukocyte infiltration. The chronic inflammatory process provokes the development of dystrophic changes in the epithelium, the infiltration of the stroma by leukocytes and the destruction of intercellular contacts, which, in turn, leads to a decrease in the hermetic function of the epithelium and a violation of the differentiation of epithelial cells during the process of metaplasia. This process is accompanied by a disturbance of local humoral immunityMetabolic disorders such as diabetes, dyslipidemia, hypertension, and obesity have also been found to overactivate the immune system, causing leukocyte activation with increased numbers of their proinflammatory phenotypes, which explains the susceptibility to chronic inflammatory diseases.Infectious agents should no longer be considered the sole cause of CE. Any condition that disrupts the balance of the immune system can lead to temporary, recurrent, or persistent CE. The last one can have various dangerous clinical and paraclinical consequences.To date, there are no recommendations that would provide proper analysis or treatment of endometrial inflammation. Therefore, the definition of clinical signs for the assessment of the global risk of development of CE for female patients is relevant. The clinical assessment of the patient’s condition should take into account her age, lifestyle, body mass index, blood pressure, atopy, stress factor, signs of chronic inflammation, as well as history of diseases mediated by inflammation.Further research into this pathological condition and the development of effective ways to prevent it are particularly relevant, which can contribute to the improvement of women’s reproductive health and their fertility.