Endometritis

Chronic endometritis (CE) is a persistent inflammatory disorder of the endometrial lining characterized by the infiltration of plasma cells in the endometrial stroma. The pathogenesis of CE seems to be related to a qualitative and quantitative alteration of endometrial microbioma. CE is a subtle and frequently missed pathology accompanied by only mild and unspecific disturbances, such as abnormal uterine bleeding, pelvic discomfort, dyspaurenia, and reproductive failures. Different studies showed that unrecognized CE may reduce the pregnancy rates and increase the abortion rates in both natural conception and assisted reproduction. Moreover, in recent years a link between CE and many gynecological pathologies (i.e., polyps, endometriosis, and possibly cancer) has been proposed. Data in literature show that in women with CE both antibiogram-guided and standard antibiotic treatments are able to improve reproductive outcomes The diagnosis of CE is a very challenging matter for physicians. Immunohistochemistry for CD138 represents the current gold standard for the diagnosis of CE but at the moment no consensus exists on diagnostic criteria. Fluid hysteroscopy is a reliable technique for diagnosing this pathology and it is the only technique in the hands of gynecologists. Biomolecular profiling of endometrial microbiome opens new perspectives in the prevention and cure of CE and of many gynecological pathologies.