Endometriosis as an Infectious Disease: Association with Chronic Endometritis

Kotaro Kitaya, Takako Mihara, Masaya Mihara
In: Clinical and Experimental Obstetrics & Gynecology · 2023 · vol. 50(1) · doi:10.31083/j.ceog5001010 · W4316038185
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review examines the link between endometriosis and chronic endometritis, suggesting they share endometrial proliferative characteristics and that CE may also reduce fecundity in women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This review discusses chronic endometritis (CE), an endometrial inflammatory/infectious condition marked by CD138(+) stromal plasmacyte infiltration, and synthesizes evidence on its relationship to endometriosis, which has also been increasingly studied for immune/inflammatory and infectious components. Across included studies, CE prevalence in women with endometriosis is reported with wide ranges (about 3%–53%), and the review attributes discrepancies largely to differences in diagnostic cutoffs and CD138 detection methods; it also notes that CE was generally not linked to endometriosis stage, with at least one study finding multiparity inversely associated with CE. The review emphasizes that definitive CE diagnosis relies on endometrial biopsy/histopathology and/or hysteroscopy, and it highlights a key limitation that CE prevalence among women with suspected/clinical endometriosis is still unclear because many studies recruit women undergoing pelvic surgery. Relevance to endometriosis: the paper is centrally about endometriosis and explicitly focuses on associations between endometriosis and chronic endometritis in terms of prevalence, infertility, and reproductive outcomes.

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Abstract

Objectives: Recent studies focus on immunological, infectious, and inflammatory aspects of endometriosis. Meanwhile, chronic endometritis (CE) is an immunological, infectious, and inflammatory disorder of the eutopic endometrium with unusual stromal plasmacyte infiltration. Mechanism: In this review article, we aimed to gain a better understanding of the relationships between endometriosis and CE. Findings in Brief: Accumulating evidence supports the idea that CE is associated with infertility of unknown etiology, repeated implantation failure in an in vitro fertilization-embryo transfer program, recurrent pregnancy loss, as well as several perinatal/neonatal complications. Endometrial biopsy/histopathologic examinations and/or hysteroscopy are required to make a definitive diagnosis of CE. Conclusions: While endometriosis has been long considered a cause of infertility, CE is also an emerging issue that may reduce fecundity in women of reproductive age. Endometriosis and CE share characteristics of endometrial proliferative nature. The potential relationships between these two diseases of the uterine lining warrant future studies.

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Condition tags

endometriosisinfertility

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References (69)

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last seen: 2026-06-10T17:14:06.276822+00:00
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