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

E.G. Shvarev, A.R. Zoeva, И. В. Зайцев
In: Russian Bulletin of Obstetrician-Gynecologist · 2025 · vol. 25(5) , pp. 35 · doi:10.17116/rosakush20252505135 · W4415419140
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review examines current data on mechanisms of endometrial hyperplasia formation and pathogenesis-oriented treatment methods for patients with hyperplastic processes in the endometrium combined with chronic endometritis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

The paper discusses the management of patients with hyperplastic processes of the endometrium (including risk of recurrence and malignant transformation) when combined with chronic endometritis, framing the problem using endocrine–inflammatory and receptor-resistance concepts. It outlines diagnostic approaches (histology with immunohistochemistry, imaging, biopsy/hysteroscopy) and contrasts general RCOG/ROAG-style treatment pathways with a proposed stepwise, pathogenesis-oriented regimen for the combined condition, including antimicrobial/antiviral and immunomodulatory measures, use of proteolytic agents to improve drug penetration, and discussion of epigenetically oriented supplements such as EGCG; it also notes that there are no reliable clinical methods to precisely assess and fully correct endometrial receptor dysfunction before and during therapy. Key caveats emphasized include diagnostic and treatment-planning difficulty and potential limits in evaluating response, with exploratory biomarkers in blood/menstrual fluid (e.g., glycoprotein markers, ceruloplasmin) presented as possible tools. Relevance to endometriosis: chronic endometritis is discussed via an inflammatory/infectious “alternative concept” in which pelvic inflammatory processes may initiate hyperproliferative pelvic disorders including endometriosis, and endometrial hyperplasia is framed as part of this broader inflammatory pathway, though the paper’s main focus is combined management of endometrial hyperplasia and chronic endometritis.

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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.

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disambig:endometritis

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