Abstract:

Endometriosis (EMs) is a common benign gynecological disease among women of childbearing age. An increasing number of clinical studies have found that the risk of chronic endometritis (CE) is elevated in patients with EMs. The negative impacts of both conditions on female reproductive capacity have also drawn extensive attention. The potential pathogenesis of EMs complicated with CE may be related to immune-inflammatory state, steroid hormones, microbial pathogens, and microRNAs. As an inflammatory disease, the immune-inflammatory changes caused during the pathogenesis of EMs directly promote the development of CE. Abnormal concentrations of estrogen and progestogen in steroid hormones, especially elevated estrogen levels, contribute to the co-occurrence of EMs and CE. The imbalance of intra- and extra- uterine flora accelerates the co-pathogenesis of EMs and CE through local immune abnormalities and inflammatory responses. As regulators of gene expression, microRNAs also play a role in the co-morbidity process by influencing the expression of proteins in various pathways. The co-occurrence of EMs and CE further impairs endometrial receptivity and affects female reproductive capacity. This review summarizes the pathogenesis of EMs complicated with CE and its impact on reproduction, aiming to provide new ideas and evidence for the treatment of EMs.

Key words: Endometriosis, Endometritis, Reproduction, MicroRNAs, Immunity, Inflammation, Chronic endometritis