Adenomyosis and chronic endometritis: cause, consequence or coincidence? A systematic review and meta-analysis

Marcel Steinmann, Dimitrios Rafail Kalaitzopoulos, Kalaitzopoulos DR, Alexandra Kohl Schwartz, Alexandra Sabrina Kohl Schwartz, Schwartz ASK, Tanya Karrer, Karrer T, Michael von Wolff, von Wolff M, Angela Vidal, Vidal A
Reproductive BioMedicine Online · 2026 · vol. 52(6) , pp. 105472 · doi:10.1016/j.rbmo.2026.105472 · PMID:42030756 · W7124757989
Systematic review / meta-analysis OA: hybrid CC0
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This systematic review and meta-analysis found a 32% prevalence of chronic endometritis in women with adenomyosis, and a significantly higher risk of chronic endometritis in these women compared to controls.

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Abstract

Chronic endometritis is persistent inflammation of the endometrium, often underdiagnosed due to its oligosymptomatic presentation. Both chronic endometritis and adenomyosis share inflammatory and structural alterations of the endometrial-myometrial interface that may impair reproductive outcomes. This systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, and registered in PROSPERO. MEDLINE, Embase, CENTRAL, Cochrane Database of Systematic Reviews, Scopus and trial registries were searched from 2000 to May 2025 to determine the prevalence of chronic endometritis in women with adenomyosis, and assess the strength of their association. Of 713 identified records, 10 studies (n = 2877 women) met the inclusion criteria. The pooled prevalence of chronic endometritis in women with adenomyosis was 32% (95% CI 16-53; I² = 94%). In subgroup analyses, prevalence varied by the diagnostic method used for adenomyosis: hysterectomy (21%), magnetic resonance imaging (64%), and hysteroscopy (8%). Meta-analysis demonstrated a significantly higher prevalence of chronic endometritis in women with adenomyosis compared with controls (OR = 3.81, 95% CI 2.23-6.50; I² = 11%). This systematic review and meta-analysis suggest that adenomyosis and chronic endometritis frequently coexist, with women with adenomyosis showing a significantly higher risk of chronic endometritis. Standardized diagnostic criteria, adenomyosis subtype classification, and high-quality randomized controlled trials are needed to clarify the underlying mechanisms, and are necessary to demonstrate an association between adenomyosis and chronic endometritis.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (60)

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