Features of treatment of patients with hyperplastic processes in the endometrium in combination with chronic endometritis

Shvarev E.G.; Zoeva A.R.; Zaitsev I.V.

doi:https://doi.org/10.17116/rosakush20252505135

Close metadata

Recommended articles:

Structural and biochemical features of menstrual discharge in patients with uterine fibroids. Russian Bulletin of Obstetrician-Gynecologist. 2024;(6):85-90

Virus-associated progesterone-resistant chronic endometritis — the oncorisk situation?. Russian Bulletin of Obstetrician-Gynecologist. 2025;(1):25-30

Ozone therapy in pregravidar preparation for the application of assisted reproductive technology programs. Russian Bulletin of Obstetrician-Gynecologist. 2025;(5):67-74

Morpho-functional features of the endometrium in uterine leiomyoma before and after embolization of the uterine arteries. Russian Journal of Archive of Pathology. 2025;(4):13-23

Abstract:

In recent decades, there has been an increase in the incidence of hormone-dependent pre-tumor and tumor formations of reproductive organs, including hyperplastic processes in the endometrium (HPE). The urgency of the problem of a combination of chronic endometritis (CE) and HPE formed against this background is due not only to the difficulties of diagnosis, but also to the possibility of recurrence and the risk of malignancy. There are still heterogeneous views on the features of the pathogenesis of the considered pathological proliferative processes, which explains the difficulties of diagnosis, choice of treatment methods and evaluation of their effectiveness. This review presents current data on the main mechanisms of endometrial hyperplasia formation and pathogenesis-oriented treatment methods for patients.

Keywords:

chronic endometritis

hyperplastic processes in the endometrium

treatment approaches

Authors:

Shvarev E.G.

Astrakhan State Medical University

ORCID: 0000-0003-0440-9236

Zoeva A.R.

Astrakhan State Medical University

ORCID: 0000-0001-8596-6514

Zaitsev I.V.

Astrakhan State Medical University

ORCID: 0000-0003-3641-1947

Received:

04.09.2024

Accepted:

27.09.2024

Close metadata

References:

Ghoubara A, Sundar S, Ewies AAA. Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women. Climacteric. 2018;21:4:391-396. https://doi.org/10.1080/13697137.2018.1461825
Endometrial Cancer Statistics World Cancer Research Fund International. [(accessed on 5 August 2022)]. https://www.wcrf.org/cancer-trends/endometrial-cancer-statistics/
Global Cancer Observatory. WHO Cancer Today. [(accessed on 11 November 2022)]; Available online: https://gco.iarc.fr/today/home
Lyzikova YuA. Features of production and reception of sex hormones in patients with chronic endometritis. Akusherstvo i ginekologiya. 2020;12:144-148. (In Russ.). https://doi.org/10.18565/aig.2020.12.144-148
Russo M, Newell JM, Budurlean L, Houser KR, Sheldon K, Kesterson J, Phaeton R, Hossler C, Rosenberg J, DeGraff D, Shuman L, Broach JR, Warrick JI. Mutational profile of endometrial hyperplasia and risk of progression to endometrioid adenocarcinoma. Cancer. 2020;126:12:2775-2783. https://doi.org/10.1002/cncr.32822
Jeong O, Broaddus RR, Lessey BA, Risinger JI, Hunter MI, Kim TH. MIG-6 is critical for progesterone responsiveness in human complex atypical hyperplasia and early-stage endometrial cancer. Int J Mol Sci. 2022;23:23:14596. https://doi.org/10.3390/ijms232314596
Bokhman YaV. Guide to gynecological oncology. Moscow: Kniga po Trebovaniyu. 2012:464. (In Russ.).
Ferenczy A, Gelfand MM. В кн.: Гинекология по Эмилю Новаку. Под ред. Дж. Берека, И. Адаши, П. Хиллард. М.: Практика. 2002;267.
Kazachkov EL, Zatvornitskaya AV, Voropaeva EE, Kazachkova EA, Shchegolev AI. Features of proliferative and antiproliferative activity of endometrial cells in its hyperplasia in combination with chronic endometritis. Akusherstvo i ginekologiya. 2019;8:100-106. (In Russ.).
Kabodmehri R, Etezadi A, Sharami SH, Ghanaei MM, Hosseinzadeh F, Heirati SFD, Pourhabibi Z. The association between chronic endometritis and uterine fibroids. J Family Med Prim Care. 2022;11:2:653-659. https://doi.org/10.4103/jfmpc.jfmpc_1470_21
Kitaya K, Yasuo T. Commonalities and disparities between endometriosis and chronic endometritis: Therapeutic potential of novel antibiotic treatment strategy against ectopic endometrium. Int J Mol Sci. 2023;24:3:2059. https://doi.org/10.3390/ijms24032059
Unanyan AL, Sidorova IS, Kossovich YuM, Kogan EA, Demura TA. Chronic endometritis and HPV: disturbing news. The role of the combination of HPV infection and chronic endometritis in the pathogenesis of endometrial malignant tumors. Status Praesens. 2012;3:21-25. (In Russ.).
Kazachkova EA, Zatvornitskaya AV, Voropaeva EE, Kazachkov EL. Endometrial hyperplasia combined with chronic endometritis: clinical and morphological features. Ural’skii meditsinskii zhurnal. 2020;3:186:36-41. (In Russ.).
Vereshchahina TV, Boychuk AV, Yakymchuk YB, Nikitina IM, Datsko TV. Morphological changes of the endometrium in hyperplastic process in women of reproductive age. Wiad Lek. 2021;74:388-394.
Metlitskaya MA, Rogov YuI. Analysis of the frequency of occurrence of papillomavirus infection in hyperplastic processes of the endometrium and adenocarcinomas. Meditsinskie novosti. 2012; 12:78-79. (In Russ.).
Mlodzik N, Lukaszuk K, Sieg W, Jakiel G, Smolarczyk R. Endometrial microbiota — do they mean more than we have expected? Ginekol Pol. 2020;91:1:45-48. https://doi.org/10.5603/GP.2020.0010
Kapetanios V, Lampraki M, Georgoulias G, Kasdaglis S, Kliafas S, Gkavra N, Xountasi M, Tsilivakos V, Leventopoulos M. Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis. Heliyon. 2024;10;9:e30259. https://doi.org/10.1016/j.heliyon.2024.e30259
Radzinskii VE, Kiselev VI, Muizhinek EL, Ordiyants IM, Dobretsova TA. Chronic endometritis and fertility: new answers. Status Praesens. 2016;18:76:5. (In Russ.).
Radzinskii VE, Ipastova ID. Subclinical PID: from awareness of danger to action plan. Informationnyi byulleten’. Status Praesens. 2017;6. (In Russ.).
Baracat MCP, Baracat EC, Simões RS, Simões MJ, Maciel GAR, Azziz R, Soares Jr. JM. Hormonal and metabolic factors influence the Action of progesterone on the endometrium of women with polycystic ovary syndrome. Diagnostics (Basel). 2023;13:3:382. https://doi.org/10.3390/diagnostics13030382
Wang Y, Zhang L, Che X, Li W, Liu Z, Jiang J. Roles of SIRT1/FoxO1/SREBP-1 in the development of progestin resistance in endometrial cancer. Arch Gynecol Obstet. 2018;298:5:961-969. https://doi.org/10.1007/s00404-018-4893-3
Pu H, Wen X, Luo D, Guo Z. Regulation of progesterone receptor expression in endometriosis, endometrial cancer, and breast cancer by estrogen, polymorphisms, transcription factors, epigenetic alterations, and ubiquitin-proteasome system. J Steroid Biochem Mol Biol. 2023;227:106199. https://doi.org/10.1016/j.jsbmb.2022.106199
Tapil’skaya N.I., Gzgzyan A.M., Kogan I.Yu. The hidden causes of reproductive failure. Viral infections in the development of chronic endometritis. Status Praesens. Akusherstvo, ginekologiya, besplodnyj brak. 2019;4:59:118-124. (In Russ.).
Lv M, Chen P, Bai M, Huang Y, Li L, Feng Y, Liao H, Zheng W, Chen X, Zhang Z. Progestin Resistance and Corresponding Management of Abnormal Endometrial Hyperplasia and Endometrial Carcinoma. Cancers (Basel). 2022;14:24:6210. https://doi.org/10.3390/cancers14246210
Clinical guidelines. Endometrial hyperplasia. Coding according to the International statistical classification of diseases and related health problems: N85.0, N85.1 Year of approval (revision frequency): 2021. Developer of the clinical guideline: Russian Society of Obstetricians and Gynecologists. (In Russ.).
Erofeeva LG, Sidorkina AG, Novopashina GN, Erofeev BB. Modern understanding of the problem of endometrial hyperplasia. Nauchnoe obozrenie. Meditsinskie nauki. 2022;6:82-88. (In Russ.).
Zarochentseva NV, Arshakyan AK, Men’shikova NS, Titchenko YuP. Chronic endometritis: etiology, clinical features, diagnostics, treatment. Russian Bulletin of Obstetrician-Gynecologist. 2013;5:21-27. (In Russ.).
Unanyan AL, Sidorova IS, Kogan EA, Baburin DV. Clinical and pathogenetic features of hyperplastic processes of the endometrium in women of perimenopausal age. RMJ «Meditsinskoe obozrenie». 2018;1:I:67-71. (In Russ.).
Tsonis O, Gkrozou F, Dimitriou E, Barmpalia Z, Tsonis K, Vatopoulou A, Paschopoulos M. Hysteroscopic features suggestive of chronic endometritis: a systematic review. Hum Fertil (Camb). 2023;26:6:1530-1543. https://doi.org/10.1080/14647273.2023.2265155
Gallos ID, Alazzam M, Clark T, Faraj R, Rosenhal AN, Smith PP, Gupta JK. RCOG Green-top Guideline: Management of Endometrial Hyperplasia, 2016 // www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_endometrial_hyperplasia.pdf.(2May2016,datelastaccessed).
Auclair M-H, Yong PJ, Salvador S, Thurston J, Colgan TTJ, Sebastianelli A. Guideline No. 392 — Classification and management of endometrial hyperplasia. J Obstet Gynaecol Can. 2019;41:12:1789-1800. https://doi.org/10.1016/j.jogc.2019.03.025
Kuznetsova IV. Russian and international approaches to the management of patients with endometrial hyperplasia. Obstetrics and gynecology. Portal CON-MED.RU. 2020. (In Russ.).
Mal’tseva LI, Sharipova RI, Tsyplakov DE, Zhelezova ME. Morphofunctional state of the endometrium in women with bacterial-viral endometritis. Akusherstvo, ginekologiya. 2017;7:108:87-92. (In Russ.).
Tkachenko LV, Sviridova NI. Modern approach to the treatment of chronic endometritis in patients with hyperplastic processes of the endometrium. Doktor.Ru. 2016;7:124:15-20. (In Russ.).
Zoeva AR, Posiseeva LV, Dikareva LV, Shvarev EG. Endometrium: norm and pathology. Study guide. Astrakhan’. 2024;68-77. (In Russ.).
Nazarenko TA, Dubnitskaya LV. Possibilities of using the enzyme preparation Longidaza in complex therapy of pathological changes in the endometrium. Ginekologiya. 2007;9:2:27-30. (In Russ.).
Tsar’kova MA, Sementsova NA. A new approach to the combination therapy of patients with endometrial pathology. Rossiiskii vestnik akushera-ginekologa. 2014;14:5:50-53. (In Russ.).
Sulima AN, Davydova AA, Rybalka AN, Beglitse DA, Baskakov PN. Features of prevention and treatment of the adhesive process in women with chronic diseases of the pelvic organs. Ginekologiya. 2018;20:1:20-24. (In Russ.).
Tapil’skaya NI, Kopylova AA, Budilovskaya OV, Krysanova AA, Khusnutdinova TA, Savicheva AM. Evaluation of the effectiveness of bovhyaluronidase azoximer in the treatment of chronic endometritis in women with implantation failures. Zhenskaya klinika. 2020;2:1-4. (In Russ.).
Trizna EYu, Kayumov AR. Effect of in vitro isolated and combined with antibacterial agents use of bovhyaluronidase azoximer on the integrity of bacterial biofilm and the viability of microorganisms. Eksperimental’naya i klinicheskaya farmakologiya. 2020; 83:2:38-44. (In Russ.).
Gaidukov SN, Arutyunyan AF. Efficiency of hormone therapy and targeted drugs in the treatment of endometrial hyperplasia in combination with adenomyosis. Sovremennye problemy nauki i obrazovaniya. 2015;6:269. (In Russ.).
Negri A, Naponelli V, Rizzi F, Bettuzzi S. Molecular Targets of Epigallocatechin — Gallate (EGCG): a special focus on signal transduction and cancer. Nutrients. 2018;10;12:1936.
Mal’tseva LI, Kiselev VI, Poloznikov AA. Efficiency of therapy of chronic endometritis with epigallocatechin-3-gallate in women with reproductive dysfunction. Prakticheskaya meditsina. 2019; 17:4:62-67. (In Russ.).
Dobrokhotova YuE, Saprykina LV, Narimanova MR, Ibragimova DM. Possibilities of non-hormonal therapy of endometrial hyperplasia without atypia in reproductive age. Zhenskaya klinika. 2020;1:64-70. (In Russ.).
Kuznetsova IV. Adjuvant therapy for uterine fibroids and genital endometriosis. Effektivnaya farmakoterapiya. 2021;17:19:20-30. (In Russ.). https://doi.org/10.33978/2307-3586-2021-17-19-20-30
Maybin JA, Critchley HO. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update. 2015; 21:748-761. https://doi.org/10.1093/humupd/dmv038
Kachalina TS, Motovilova TM, Borovkova LV, Grechkanev GO, Ponomareva IV, Puchkova TN, Mart’yantseva IV, Zamyslova VP, Zinov’eva OS, Chikalova KI, Sirotina LZ. An integrative assessment of menstrual blood biomarkers in the diagnosis of non-neoplastic endometrial pathology. Akusherstvo i ginekologiya. 2019; 3:121-126. (In Russ.). https://doi.org/10.18565/aig.2019.3.121-126
Taranovska OO, Likhachov VK, Dobrovolska LM, Makarov OG, Shymanska YaV. Possibility for non-invasive diagnosis of chronic endometritis in women at risk during pregravid preparation. Wiad Lek. 2019;72:1:64-67.
McFadyen JD, Zeller J, Potempa LA, Pietersz GA, Eisenhardt SU, Peter K. C-reactive protein and its structural isoforms: An Evolutionary conserved marker and central player in inflammatory diseases and beyond. Subcell Biochem. 2020;94:499-520. https://doi.org/10.1007/978-3-030-41769-7_20
Zoeva AR, Dikareva LV, Teplyi DL, Ayupova AK. Patent. 2587720 Russian Federation, IPC G01N33/48. Method for diagnosing chronic endometritis in women with abnormal uterine bleeding. Applicant and patent holder — State Budgetary Educational Institution of Higher Professional Education “Astrakhan State Medical Academy” of the Ministry of Health of the Russian Federation. No. 2014149540/15; declared 08.12.2014; published 20.06.2016. Bulletin No. 17. (In Russ.).