Exploring the Association Between Chronic Endometritis and the Risk of Endometrial Hyperplasia

Background: chronic inflammation of the inner layer of the uterus ( endometrium ) play a role in different gynecological and obstetrical complaints including infertility, abnormal uterine bleeding, miscarriage, and implantion failure in patients underwent invitro fertilization. Patients and methods: This prospective ( case-control study ) was done including 400 women (200 cases, 200 control). Women with abnormal uterine bleeding and women with subfertility were included. These patients underwent dilatation and curettage under General anasthesia and endometrial samples were obtained,These specimens were examined histologically and by IHC marker assessments using CD138 for confirmation of chronic endometritis. Results: 161 ( 80.5%) case presented with abnormal vaginal bleeding and 39 case ( 19.5%) presented with infertility, 120 case ( 60%) had chronic pelvic pain, recurrent pregnancy loss was demonstrated in 111 case ( 55.5%). All the cases 200 case had endometrial hyperplasia while the control group appear to be either secretory or proliferative endometrium according to time of curate ( day of cycle). There is significant association between abnormal uterine bleeding and history ofrecurrent pregnancy loss and endometrial hyperplasia. 20% ( 40 case) of endometrial hyperplasia were diagnosed to have chronic endometritis and confirmed by IHC ( CD138) which was significant result and 80% (160 case) were negative both in histopathological and IHC marker and appear to be significant with OR (0.44) and 95% CI (0.28-0.68), Conclusion: The current study shows there is a clear association and possible etiopathogenic link between chronic endometritis and endometrial hyperplasia .Treatment of chronic endometritis even if asymptomatic might help in decreasing the incidence of endometrial carcinoma.