Endometrium Of Women Research Articles

Estro-progestin and progestogen intake: What's the impact on hysteroscopic imaging?

In current literature there is no report aimed to evaluate the effects of exogenous steroids on hysteroscopic imaging. To evaluate the hysteroscopic features of endometrium in women undergoing female hormones administration. We reviewed video-records of hysteroscopies carried-out in women taking estro-progestins (EP), progestogen (P) and Hormonal Replacement Therapy (HRT). All women underwent biopsies resulting in atrophic, functional, or dysfunctional pathological reports. Description of hysteroscopic pictures related to each schedule of therapy. The study included 117 women. We evaluated 82, 24 and 11 women treated by EP, P and HRT, respectively. In EP users, imaging indistinguishable from physiological pictures was found when high oestrogen dosage and low-potency progestogen as 17-OH progesterone derivatives were administered. By enhancing progestogen potency with 19-norprogesterone and 19-nortestosterone derivatives we observed a promotion of progestogen differentiation such as polypoid-papillary pseudo-decidualisation, spiral artery differentiation, inhibition of gland-proliferation and endometrial atrophy. In P users we distinguished two patterns, depending on continuous or sequential schedules. Continuous therapy resulted in atrophic or proliferative-secretory features whereas sequential ones led to endometrial overgrowth reflecting stromal pseudo-decidualisation. Women undergoing HRT showed atrophic features in combined continuous and polypoid overgrowth in sequential schedules. In women taking Tibolone we found pictures ranging from atrophic to hyperplastic appearances. Exogenous steroids lead to significant endometrial moulding. Depending on schedule, hysteroscopic-view appears predictable and often showing overgrowths mimicking proliferative pathologies. In this case biopsy is recommended but in common practice physicians should gain awareness with hysteroscopic pictures induced from hormone administration. Systematic assessment of hysteroscopic pictures during estro-progestins intake.

Uterine natural killer cells during the implantation window period in women veterans experienced by injury with unrealished reproductive function

Annotation. Against the background of stress and post-traumatic stress disorder (PTSD) in women, changes in the hormonal background improve – the levels of stress hormones and the morphofunctional endometrium, which in their change negatively affect the reproductive health of women in Ukraine. The purpose of this study was to increase the efficiency of diagnosis and treatment of pathology and implantation capacity of the endometrium in women of reproductive age who took part in hostilities and suffered a concussion. Uterine natural killer cells were studied during the implantation window in 487 women of reproductive age who participated in combat operations and suffered concussions, who underwent hysteroscopy with endometrial sampling for histological examination and scanning electron microscopy on the 21st day of menstruation cycle (MC). Of these women, 246 patients – the comparison group – of reproductive age with a history of trauma without post-concussive syndrome and 211 in the main group, women of reproductive age who have consequences of concussion in the form of post-concussive syndrome. 30 conditionally healthy civilian women of reproductive age served as controls. The average age of the examined was 37.08±4.23 years. The period of stay in the combat zone is 60.26±42.21 months, the time since receiving a traumatic brain injury (concussion) is 18.8±9.2 months. Instrumental examination of women included hysteroscopy. The spectrum of MNC cells (CD16+ and CD56+) in the stroma of the endometrium on the 21st day of MC was determined. Microscopy of the preparations and all morphometric studies were performed on an Olympus AX70 Provis microscope (Olympus, Japan) using the image analysis program Analysis 3.2 Pro (Soft Imaging, Germany) according to the recommendations of the software manufacturer. The obtained results were processed using the Statistica 6.0 and Biostat software packages and methods of analytical statistics. It is established that in women military servicemen, participants in combat operations who suffered a concussion, the content of CD56+ and CD16+ cells in the stroma of the endometrium in women with post-concussion syndrome is greater than that in patients without post-concussion syndrome: in the endometrium, which corresponds to the proliferation phase, it is 1.45 (p<0.0001) and 1.64 times (p<0.0001), in the endometrium, which corresponds to the early secretion phase, 1.93 (p<0.0001) and 2.22 (p<0,0001), in the endometrium, which corresponds to the middle phase of secretion, – in 1.61 (p<0.0001) and in 3.42 (p<0.0001), in chronic endometritis – in 1.92 (p<0 .0001) and 1.94 (p<0.0001), with SAHE – in 1.79 (p<0.0001) and 1.51 (p<0.0001), with endometrial polyps – in 1, 60 (p<0.0001) and at 1.56 (p<0.0001). This study proves the need to improve the efficiency of diagnosis and treatment of endometrial pathology in women of reproductive age who participated in hostilities and suffered concussions.

Increased cytotoxic natural killer cells in the endometrium alone cannot be considered the immunological cause of recurrent miscarriage

To study the distribution and gene expression of endometrial immune cell populations, especially natural killer (NK) subsets, between assisted reproductive technology patients and healthy donors and explore a possible relationship of these results with patients' killer cell immunoglobulin-like receptor (KIR) genotypes and KIR-human antigen leukocyte-C (HLA-C) binding. Prospective observational cohort study. Clinic and university laboratories. Participants included 39 women with recurrent miscarriages who had undergone invitro fertilization cycles with donated oocytes and 21 healthy oocyte donors with proven fertility. Endometrial biopsy samples were collected from both patients and donors, and the KIR genotypes of the assisted reproductive technology patients were analyzed. Endometrial gene expression (cluster of differentiation [CD] antigens and anti-inflammatory and proinflammatory interleukins) and the number and percentage of regulatory T and NK cell populations in patients and donors were determined. Subsequently, the results obtained were categorized in the group of patients by KIR genotype. Killer cell immunoglobulin-like receptor-HLA-C binding was also examined in patients, considering their KIRs. A higher percentage of CD56dimCD16+ NK cells were observed in patients than those in healthy donors. Nevertheless, when categorizing patients by KIR genotype and comparing the KIR AA (35.9%), AB (43.6%), and BB (20.5%) groups, no statistically significant difference was observed in either endometrial gene expression or any of the immune cell populations analyzed. Finally, no differences in binding between KIR and HLA-C molecules were registered among these 3 sets of patients. The reported increase in the number of NK cells with a cytotoxic profile in the endometrium of women with a history of recurrent miscarriages cannot alone explain these events because no relationship is observed between such cellular increase and the KIR genotypes, which individually, and in combination with the different HLA-C alleles, have also been associated, by previous studies, with negative reproductive outcomes. 1405-MAD-025-JG.

Circ_0115118 regulates endometrial functions through the miR-138-1-3p/WDFY2 axis in patients with PCOS†.

To investigate the expression profiles of circular RNAs (circRNAs) in the endometria of women with polycystic ovary syndrome (PCOS) and to explore the role of aberrant circ_0115118 expression in endometrial dysfunction in patients with PCOS. CircRNA microarray hybridization and bioinformatic analyses were performed to determine the expression patterns of circRNAs in the endometria of patients with or without PCOS, the expression of target circRNA was evaluated by real-time polymerase chain reaction (PCR). Cell counting kit-8 and Transwell assays were used to detect cellular proliferative, invasive, and migratory capacities. The influence of the circRNA on decidualization was explored by real-time PCR. Animal models were established to investigate the regulatory effect of the circRNA on embryo implantation. Downstream microRNAs and genes were predicted using bioinformatic websites and verified by dual-luciferase reporter assays, real-time PCR, and western blotting. In the endometria of patients with PCOS, there were 113 differentially expressed circRNAs in the secretory phase and 1119 differentially expressed circRNAs in the proliferative phase. The expression of circ_0115118 was significantly higher in endometrial stromal cells during the proliferative phase in patients with PCOS, leading to inhibition of cellular mobilization and embryo implantation. In addition, circ_0115118 exerted effects by sponging miR-138-1-3p, subsequently increasing the expression of WD repeat and FYVE domain-containing protein 2 (WDFY2). Circ_0115118 expression is dysregulated in the endometria of patients with PCOS and adversely affects endometrial function. Our findings reveal that circ_0115118 may be a potential therapeutic target to improve pregnancy outcomes in women with PCOS.

From Retrograde Menstruation to Endometrial Determinism and a Brave New World of "Root Treatment" of Endometriosis: Destiny or a Fanciful Utopia?

Practically unknown outside of China, the "endometrial determinism" theory was proposed to account for the apparent gap between the relatively low prevalence of endometriosis and nearly universal retrograde menstruation. Attracting uncritical advocacy, the theory culminates in a recent consensus by elite Chinese gynecologists in favor of "root treatment", intended to nip endometriosis in the bud. Correcting endometrial "defects" can gain further momentum by the presence of cancer-driver mutations such as KRAS mutations in the endometrium of women with endometriosis and the recent introduction of therapeutics aiming to rectify the effect of these mutations for cancer treatment. We provide a critical appraisal of evidence for endometrial aberrations in endometriosis and relevant experimental evidence. All available evidence of endometrial "defect" is invariably post hoc and may well be secondary to induced endometriosis. We propose that the theory of "endometrial determinism" needs to demonstrate a clear causal and a phylogenetic relationship between endometrial aberrations and endometriosis. We argue that while it is highly likely that endometriosis is a consequence of retrograde menstruation, the case that molecular aberrations as a sole or a necessary determinant remains to be proven. "Root treatment" is a worthy ambition but as of now it is close to a fanciful Utopia.

Hormonal and Metabolic Factors Influence the Action of Progesterone on the Endometrium of Women with Polycystic Ovary Syndrome.

Hormonal and metabolic factors may influence endometrial quality and interfere with the action of progesterone. Therefore, the aim of our study was to address this issue. Participants were recruited from an outpatient reproductive endocrinology clinic at an academic tertiary medical care centre. All subjects underwent endometrial biopsy (EB) in the follicular phase of the cycle prior to treatment. Thereafter, they were treated with micronized progesterone (400 mg/day × 10 days intravaginally) from days 14-28 of the next cycle. A second EB was performed between days 21-24 of the cycle (the second phase). The metabolic and hormonal serum levels were evaluated during the implantation window. EB samples were analysed using light microscopy for histomorphometric analysis. The endometrium of women with Polycystic Ovarian Syndrome (PCOS) in the second phase demonstrated a uniform surface epithelium with less leukocyte infiltration and an absence of apoptotic figures compared to the control group. (p < 0.021). The thickness of the surface epithelium in the second phase of the PCOS group correlated positively with free and bioavailable testosterone values. The number of stromal cells increases with increasing insulin levels. Our results suggest that histomorphometric abnormalities of the endometrium persist and are linked to androgen and insulin levels despite progesterone supplementation in PCOS.

Влияние COVID-19 на репродуктивное здоровье женщин. Обзор литературы

Coronavirus disease (COVID-19), in addition to affecting the respiratory system, can also lead to extrapulmonary damage in the cardiovascular system, liver, kidney, neurological, intestinal, endocrine dysfunction, as well as disorders in the reproductive system. This manuscript reviews current information on the impact of coronavirus infection on women’s reproductive health. Evidence is presented on the likely mechanisms of abnormalities in the female reproductive system. Issues such as menstrual disorders after coronavirus infection, the impact of the SARS-CoV-2 virus on the hypothalamic-pituitary system are considered. Possible mechanisms of the effect of the virus on the endometrium in women are presented. Studies on the effect of SARS-CoV-2 virus on the course of pregnancy, the outcome of childbirth, and data on possible transplacental transmission from mother to fetus are reviewed.

Histopathological changes in the uterus in women with abnormal uterine bleeding – A 2-year hospital-based retrospective study in a tertiary care center in Assam, India

Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.

The role of mast cells in physiological and complicated pregnancy

Mast cells (MCs) are highly differentiated and multifunctional immune cells. The importance of TC has been established not only as mediators of allergic reactions, but also for the development of an immune response, the occurrence of certain autoimmune diseases, tissue homeostasis, the formation of immunotolerance and metastasis of malignant tumors. MCs are present in the endometrium of women in various value depending on age, the phase of the menstrual cycle, the presence of pregnancy. Out of pregnancy, MCs are involved in the cyclic transformation of the uterine mucosa. At the onset of pregnancy, MCs stimulate the process of remodeling of the spiral arteries, the production of leukemia-inhibiting factor (LIF), which is the main implantation factor, and contribute to the formation of an immunotolerant state of the mother in relation to the fetus. Obstetric complications are accompanied by a variable content of MCs, which is associated with different genesis of diseases. A low amount of MCs is associated with impaired implantation and the development of early preeclampsia, an increased content of MCs is observed in the presence of a pathological inflammatory reaction that accompanies late preeclampsia. This review is devoted to the significance of MCs and their mediators in the physiological course of pregnancy, as well as their participation in the pathogenetic mechanisms of pregnancy complications.

Endometrial Pathology and Reproductive Outcomes in Polycystic Ovary Syndrome (PCOS)

Introduction: The common and key in the pathogenesis of PCOS and chronic endometritis (CE) is the chronic course of inflammation. Persistent damage to the endometrium leads to impaired endometrial receptivity and creates conditions for the development of infertility. The purpose of the study was to identify the most common endometrial pathology in women with PCOS and infertility and to analyze the effectiveness of infertility treatment in women with this pathology, to evaluate reproductive outcomes. Materials and methods: Analyzed 240 case histories of patients of LLC “Clinic of Professor Pasman”, Novosibirsk Clinical Oncological Dispancery for the period 2012-2022, diagnosed with PCOS, Infertility. Patients were included in the study group by random sequential selection. The frequency of occurrence of each of the PCOS phenotypes was analyzed, as well as the prevalence of endometrial pathology. The most common pathology is chronic endometritis, therefore, in addition to the standard methods of treating infertility in PCOS, CE was additionally treated by the following methods: photodynamic therapy (PDT) and the introduction of a macrophage medium into the uterine cavity. Results and discussion: In 61% of cases, hysteroscopy was performed and endometrial pathology was detected, which indicates the need to diagnose the endometrium in women with PCOS, especially before using ART. The most common endometrial pathology is chronic endometritis (61.6%). PDT and the introduction of macrophage medium increase the effectiveness of the treatment of CE and infertility in PCOS. The results obtained indicate a high incidence of PCOS without hyperandrogenism and obesity.

Оценка транскриптома эндометрия при повторных неудачах имплантации в программах вспомогательных репродуктивных технологий

Objective of the Review: A review the results of published scientific research on the special characteristics of endometrium in women with recurrent implantation failures. Key points. Endometrial receptivity and the importance of its analysis in women with recurrent implantation failures undergoing assisted reproductive treatment were considered. We analysed the current literature data confirming that various pathological conditions of the woman’s body may disturb the implantation process. Timely identification of such conditions may help clinical physicians to better understand and improve the state of the woman’s organism during the implantation window. Relevant published articles by Russian and international authors in the eLIBRARY and PubMed search systems from 2011 to 2021 were analysed. The following key words were used in the search: “endometrial receptivity”, “recurrent implantation failures”. Within the analysed timeframe, 294 articles were published in eLIBRARY and 1,537 articles were published in PubMed. Literature review covered the research on finding the causes of recurrent implantation failures and studying endometrial receptivity characteristics with the use of the molecular genetic test (ERA–test). The impact of organic and somatic pathology in the woman’s body (in particular, endometriosis, chronic endometritis, obesity) and its affect on the endometrial receptivity were described. Conclusions. Мodern molecular and genetic technologies combined with a comprehensive treatment approach may be the method of choice in certain clinical situation. Further studies have to be done to identify possibilities of transcriptomic analysis for the implementation of reproductive function in patients with recurrent implantation failures. Keywords: endometrial receptivity, recurrent implantation failures, implantation window, ERA–test.

Identification of MKNK1 and TOP3A as ovarian endometriosis risk-associated genes using integrative genomic analyses and functional experiments

The risk of endometriosis (EM), which is a common complex gynaecological disease, is related to genetic predisposition. However, it is unclear how genetic variants confer the risk of EM. Here, via Sherlock integrative analysis, we combined large-scale genome-wide association studies (GWAS) summary statistics on EM (N = 245,494) with a blood-based eQTL dataset (N = 1490) to identify EM risk-related genes. For validation, we leveraged two independent eQTL datasets (N = 769) for integration with the GWAS data. Thus, we prioritised 14 genes, including GIMAP4, TOP3A, and NMNAT3, which showed significant association with susceptibility to EM. We also utilised two independent methods, Multi-marker Analysis of GenoMic Annotation and S-PrediXcan, to further validate the EM risk-associated genes. Moreover, protein–protein interaction network analysis showed the 14 genes were functionally connected. Functional enrichment analyses further demonstrated that these genes were significantly enriched in metabolic and immune-related pathways. Differential gene expression analysis showed that in peripheral blood samples from patients with ovarian EM, TOP3A, MKNK1, SIPA1L2, and NUCB1 were significantly upregulated, while HOXB2, GIMAP5, and MGMT were significantly downregulated compared with their expression levels in samples from the controls. Immunohistochemistry further confirmed the increased expression levels of MKNK1 and TOP3A in the ectopic and eutopic endometrium compared to normal endometrium, while HOBX2 was downregulated in the endometrium of women with ovarian EM. Finally, in ex vivo functional experiments, MKNK1 knockdown inhibited ectopic endometrial stromal cells (EESCs) migration and invasion. TOP3A knockdown inhibited EESCs proliferation, migration, and invasion, while promoting their apoptosis. Convergent lines of evidence suggested that MKNK1 and TOP3A are novel EM risk-related genes.

Molecular mechanisms of resistance of endometrial hyperplasia to progestogen therapy based on the study of the expression of estrogen and progesterone receptors and paracrine cellular markers of cellular interaction

The problem of resistance of non atypical endometrial hyperplasia (NEH) to traditionally accepted, pathogenetically sound therapy with different types of progestins is currently an unsolved problem. In about 17-20% of cases there is a recurrence or even progression of atypical forms of endometrial hyperplasia (AEH), which required the use of surgical treatments. The aim of the study was to investigate the results of hormone therapy with different types of progestins for the treatment of endometrial hyperplasia in women with different types of expression of estrogen and progesterone receptors in combination with the expression of intercellular adhesion molecules E-cadherin and β-catenin to determine the cause of hormonal resistance, formation of groups of women with progestogen-sensitive endometrial hyperplasia (EH) non atypical type NEH (+), which can use progestogens for treatment, and progestogen-resistant forms of endometrial hyperplasia with non atypical NEH (-), which should be offered alternative therapy. The study was performed on the morphological material of the endometrium obtained by diagnostic biopsy in women with abnormal uterine bleeding who were diagnosed with NEH by histological examination. For immunohistochemical study, 80 endometrial samples were taken from women with abnormal uterine bleeding (AUВ) and in the same women after treatment of endometrial hyperplasia without atypia in 3 and 6 months of therapy. The control group (CG) consisted of a group of 20 women who were followed-up without treatment tactics. All women were divided into 3 groups in which different types of progestins were used for treatment: group I – continuous intake of 100 mg of micronized progesterone per os twice a day for 6 months, group II – 20 mg of dihydrogesterone per os twice a day for 6 months, group III – in which LNG-IUD was used. The state of proliferation and differentiation in the studied tissues was assessed by the expression of their key molecular participants – estrogen receptors (ERα) and progesterone (PGR), transmembrane glycoproteins of E-cadherin and β-catenin. ERα and PGR expression were determined by immu­nohistochemistry and calculated by the semi-quantitative H-index method. Evaluation of the expression of E-cadherin and β-catenin was performed by determining the percentage of IHH-positive cells to these antigens depending on the degree of their color. The criterion for the effectiveness of NEH treatment was considered to be a biopsy in 3 and 6 months of treatment in the absence of pathological changes in the endometrium. The results showed that after the use of progestogens in group I there was a change in the endometrium to the secretory type in 45% of cases, in group II with dydrogesterone therapy – in 55% there was a reduction of EH to normal histological picture. The intrauterine system with levonorgestrel (LNG-IUD) showed the greatest efficiency, with the use of which in 75% of cases normalization of the endometrial structure was observed. In the control group in 32% of cases the structure of the endometrium normalized. After 6 months of treatment with gestagens, both oral forms (micronized progesterone, dydrogesterone) and the use of LNG-IUDs showed a positive effect from their use; the therapeutic form of gestagens for therapy is not significant in reducing excessive endometrial proliferation. In the control group of patients who did not receive therapy or discontinued therapy for various reasons, it was shown that 47% of patients had spontaneous regression of EH. The overall percentage of no effect from treatment was 20% in groups I, II and III. Determination of ERα expression in all groups showed a pronounced expression in glands and stroma, which did not differ significantly in the group with NEH (+) and in NEH (-). Analysis of PGR expression of NEH in endometrium (-) showed that in glandular cells (50.82±0.73) and in the stroma (47.34±0.82) it was lower than in the endometrium of women with NEH (+) (gland 187±3.1; stroma 166.4±2.3; p&lt;0.05), as well as in the unchanged endometrium in the proliferative phase (glands 193.2±8.5; stroma 178.7±6.3; p&lt;0.05) and the secretory phase (glands 140.2±4.4; stroma 116.6±3.1; p&lt;0.05). A study of E-cadherin expression in women with EH (-) showed that in 86.4% of cases the expression was absent and in 13.6% it decreased. In NEH (+) women, 49.2% of E-cadherin expression was weak, in 34.4% – moderate, and in 16.4% – negative, indicating an association between PGR and E-cadherin expression. In women with NEH (-) there was marked cytoplasmic expression of β-catenin up to 80%, which can be interpreted as potentially threatening the progression of NEH in atypical forms and relapses. Thus, the study of molecular mechanisms of resistance of endometrial hyperplasia to progestogen therapy will help to develop a differential approach to its diagnosis and treatment.

Impact of changes in the vaginal microbiome and chronic endometritis on the initiation of hyperplastic processes of the endometrium in women

the article presents a review of the literature, which examines the impact of changes in the vaginal microbiome and chronic endometritis on the development of hyperplastic processes of the endometrium in women. Many studies have proven the undoubted role of these factors in the development of endometrial hyperplastic processes, such as atypical hyperplasia and endometrial polyposis. Chronic endometritis, on the background of which there was a course of endometrial hyperplasia, in 95.1% of women studied was caused by an infection of viral, bacterial or fungal origin. Numerous studies indicate the important role of chronic persistent infection in the development of hyperproliferative processes of the endometrium. The largest role in the pathological process is probably played by bacteria of the genus Gardnerella viridans as well as gram-positive cocci (Streptococcus). Herpes simplex virus, cytomegalovirus, human papilloma virus and pathogenic fungi represented by the genus Candida also influence the occurrence of this process. Further studies of the pathological action of these microorganisms will achieve greater accuracy in the diagnosis of hyperplastic processes of the endometrium.

Analysis of risk factors for the development of hyperproliferative endometrial processes in women of reproductive age

Based on clinical and statistical analysis, a study of the leading etiopathogenetic factors in the development of hyperplastic processes of the endometrium in patients of reproductive age was carried out.The aim of the study: to study the risk factors for hyperplasia and endometrial polyps in women of early reproductive age.Materials and methods. Clinical and statistical analysis of 120 patients of active reproductive age with verified atypical hyperproliferative pathology of the endometrium (hyperplasia and endometrial polyps) was included in the main group. The main group was divided into subgroups: Subgroup I - 45 women with endometrial hyperplasia, Subgroup II - 45 patients with endometrial polyps and Subgroup III - 30 patients with combined endometrial pathology (hyperplasia and endometrial polyps).Results of reseаrсh. The leading risk factors for the development of hyperplastic endometrial processes in women of the examined groups have been identified: aggravated heredity, high frequency of medical abortions, miscarriages and a history of abnormal births. There is a high incidence of gynecological and extragenital diseases, surgical interventions on the uterus and appendages in the examined contingent of women, which contributes to the development of endometrial pathology. It is established that the most common clinical manifestations of endometrial hyperproliferative processes are pain and hemorrhagic syndromes.Conclusions. Risk factors for hyperproliferative pathology of the endometrium in women of reproductive age are the following: burdened heredity (60.8%), concomitant extragenital pathology (57.4%), menstrual disorders (86.7%), impaired reproductive function; burdened gynecological anamnesis: chronic inflammatory processes of the uterus and appendages (45.8%), artificial (74.2%) and spontaneous (22.5%) abortions; intrauterine surgical interventions (26.7%).

A Histopathological Study of Endometrial Biopsy Samples in Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is the most common health issue in women,defined as any bleeding pattern that differs in frequency, duration, and amount. Endometrial sampling and its histopathological examination is the first-line test in patients presenting with AUB.The aim of this study was to analyze the histopathological patterns of endometrium in women with AUB and to find the predominant histopathologic pattern in the different age groups of women with AUB. The study wasconducted at the Indira Gandhi Medical College and Research Institute, Puducherry, from January 2019 to December 2020. Endometrial biopsies of patients with AUB, in whom gestational causes were ruled out, were included in this study. Out of the 160 cases analyzed, the maximum number of biopsies were from the age group of 41-50 years; the majority of patients presented with complaints of menorrhagia. The bleeding pattern was significantly associated with age groups (p=0.00). Of 160 cases, 104 cases were related to functional causes. The association of functional and organic causes with age group was not significant (p=0.67 and p=0.99, respectively). The most common histological pattern was the normal cyclical pattern showing proliferative (56) and secretory phase (30) in 86 cases. Of 42 cases of endometrial hyperplasia, 9 cases had atypical hyperplasia. The endometrial polyp was the other common organic lesion observed. Only two cases of endometrial carcinoma were reported during the present study period. Although a regular cyclical pattern is observed commonly, endometrial sampling should be considered in the peri- and post-menopausal age groups wherein the incidence of endometrial hyperplasia and endometrial carcinoma is more common.

Canonical analysis of concentrations of toxic metals in endometrium of women with gynecological disorders.

Among the main adverse environmental factors, we usually distinguish the impact of heavy metals, especially Cd and Pb. Apart from the carcinogenic and toxic properties, their potential, stimulating estrogen receptors effect (metaloestrogens) is strongly emphasized; as well as participation in gene regulation mechanisms (epigenetic). The aim of this study is to examine if there is a special scheme of concentrations of heavy metals accumulated in the female endometrium in certain pathologies: endometrial hyperplasia, endometrial cancer, endometrial polyps and miscarriages. The control group consisted of patients with abnormal uterine bleeding or functional bleeding with correct histopathological findings. The study was performed on 92 women. Microwave induced plasma atomic emission spectrometry was used to assess metals concentrations in tissue material and the results of obtained concentrations were converted to μg/kg. The calculations were performed using discriminant and canonical analyses and revealed four discriminant functions. The results showed that metal's tissue concentrations vary in different types of histopathological diagnosis and the scheme of concentrations might be characteristic for analyzed diagnosis. Pb and Al has the most substantial impact on discrimination. Endometrium may accumulate toxic metals such as: Pb, Cd, Ni, Mn, Cu, Zn, Al, Cr. It can be assumed that there are characteristic distributions of toxic metals concentrations for individual histopathological diagnoses.

Influence of pregravid preparation on the structural reorganization of the endometrium in women with chronic endometritis in infertility

Aim. To reveal the peculiarities of structural reorganization of the endometrium in various variants of pregravid preparation in women with chronic endometritis (CE) and infertility.&#x0D; Materials and methods. We examined 90 women aged 1840 who were treated for CE. For all patients, examination with microbiological (cultural) examination of the cervical canal to be separated for aerobic and facultative anaerobic microorganisms with the determination of sensitivity to antibiotics, ultrasound examination (ultrasound) of the pelvic organs and morphological examination of endometrial biopsy samples before and after treatment. All women of the study group were divided into 2 subgroups. Patients of the 1st subgroup (n=30) received standard treatment for CE antibacterial and non-steroidal anti-inflammatory drugs; in the 2nd (n=60) an additional course of immunostimulating therapy with a bacterial lipopolysaccharide preparation was prescribed.&#x0D; Results. According to the cultural method, repeated cultures from the cervical canal after treatment turned out to be sterile more often in women of the 2nd subgroup. Ultrasound diffuse-focal changes in the subendometrial zone of the myometrium occurred in all patients before and after treatment. In the 2nd subgroup, after treatment, significant changes in the endometrium were noted in the form of an increase in its thickness and a 4-fold decrease in the number of hyperechoic inclusions in the basal layer, as well as the disappearance of the irregularity of the endometrial closure line. In the endometrial biopsies of women of the 2nd subgroup, a significant decrease in the specific area of the inflammatory infiltrate, the absence of foci of fibrosis, and an increase in the thickness of the vessel wall were noted.&#x0D; Conclusion. The addition of a bacterial lipopolysaccharide to the standard CE treatment regimen not only improves the microbiological environment of the female genital tract, but also significantly affects the morphofunctional state of the endometrium.

Various endometrial patterns and abnormalities in women with postmenopausal bleeding

Objective: To study the prevalence of various histopathological changes, patterns and lesions of endometrium in women with postmenopausal bleeding. Methodology: All the fixed specimens were processed and embedded in paraffin wax. Multiple serial sections of 4-5 microns thickness were obtained from the paraffin block and then stained with H &amp; E. The observations in our study were analyzed using SPSS software version 11.5. The average values are statistically calculated using Microsoft Excel computer software. Results: This was a prospective, non interventional and observational hospital based cross sectional one year study carried out in histopathology department on endometrial biopsies and hysterectomy specimens. Out of 50 cases, postmenopausal bleeding presented at a mean age of 53.38 years and was most common within 5 years of attaining menopause. Among the endometrial causes of postmenopausal bleeding, 16% were due to benign conditions, 10% were due to malignancy and in 74 % of cases were because of non organic causes comprising of proliferative, secretory and atrophic endometrium. Atrophic endometrium was most common among non organic causes ,endometrial polyp was most common among the benign causes followed by endometrial endometrioid carcinoma was a major finding among the malignant causes.

Immunohistochemical characteristics of the endometrium in women with recurrent pregnancy loss and chronic endometritis

Objective: to study endometrium state in women with recurrent miscarriage and chronic endometritis by determining of nuclear cyclin E and syndecan-1, followed by a study of the effectiveness of proposed scheme for managing pregnancy in this category of patients.Materials and methods. Endometrium state (in particular its immunohistochemical characteristics) was studied by determining syndecan-1 in endometrial samples during hysteroscopy or pipelle biopsy in 68 women (main group) with recurrent miscarriage, followed by an analysis of the effectiveness of the proposed schemes of pregravid preparation. The women of the main group were divided into: subgroup 1 (40 pregnant women), whose treatment regimen included antibiotic therapy, folates and micronized progesterone at the pregravid stage; subgroup 2 (28 participants), whose treatment regimen included antibacterial drugs, folate at the pregravid stage and micronized progesterone from early gestation.The control group consisted of 30 re-pregnant women without a history of reproductive losses.Results. Features of the endometrium state in women with recurrent miscarriage are characterized by the presence of the CD138 protein (syndecan-1) and an abnormal (elevated) level of nuclear cyclin E, which indicates a morphological reorganization of the endometrial layer and its unpreparedness for successful implantation and further gestation. This study proved successful correction of the endometrium state at the stage of preconception preparation due to the use of micronized progesterone Utrogestan®, which consisted in reducing the percentage of reproductive losses, improving the course of pregnancy and childbirth.Conclusions. Utrogestan is a reliable, safe and effective treatment for women with recurrent miscarriage against the background of chronic endometritis even at the stage of preconception preparation. Such regimen allows transforming the endometrium and preparing it for implantation, thereby significantly improving the microenvironment for the early embryo development and successful pregnancy.