Liudmila M. Mikhaleva

Endometrial Dysfunction in Women with Ovarian and Uterine Tumors: What Is Known and What Should Be Learned?

Multimorbidity is a key global trend across healthcare fields, including gynecology. It is strongly associated with an overall poorer health status. Statistics indicate that in the 21st century most women experience at least one gynecological disease. Meanwhile, there is a consistent increase in the prevalence of obesity associated with chronic inflammation and hyperestrogenism. Alongside other factors, it leads to a growing prevalence of hyperproliferative diseases of the female reproductive system (FRS), encompassing both benign and malignant conditions. While advanced-stage malignant tumors can be linked to missed detection and wrong checkup strategies, benign neoplasms can compromise the ovarian reserve and thus cause major concerns. The prevailing benign FRS tumors are uterine fibroids (UFs) and benign ovarian tumors (BOTs), including serous and mucinous cystadenomas. It appears that an increase in certain benign FRS tumors is occurring in parallel with a rise in infertility (especially “unexplained infertility”) and reproduction failures, potentially associated with endometrial dysfunction. Thus, the endometrium is currently considered a critical area of research due to its vital role as the site of blastocyst adhesion and implantation, especially in patients with comorbidities. In this context, this article highlights the significance and pathophysiological characteristics of UFs and BOTs and their impact on defective endometrial receptivity.

Morpho-functional features of the endometrium in uterine leiomyoma before and after embolization of the uterine arteries

The question of the degree of influence of uterine artery embolization (UAE) on fertility is open. It is important to evaluate the pathomorphological structure and functional activity of the endometrium, the disruption of which can lead to infertility. Objective. To study morpho-functional changes in the endometrium of patients with uterine fibroids before and after UAE. Material and methods. 116 patients were divided into 2 groups depending on the type of the leading fibroid node: 1st — 54 patients examined with uterine fibroid (UF) types 2, 2—5, 3, 2nd — 62 patients observed with UM types 4, 5, 6. The comparison group — 30 healthy women. Aspiration biopsy of the endometrium was performed in the middle stage of the secretory phase before and 6—12 months after UAE. The percentage and maturity of pinopodes, the expression level of estrogen (ER), progesterone (PR) receptors in the glands, endometrial stroma, inflammatory markers (CD56+, CD138+) were determined. Results. The negative impact of UF on the morpho-functional state of the endometrium was determined. Changes were more pronounced in patients of 1st group. Stroma indices before and after UAE corresponded to comparison group in most patients. After UAE, the number of mature pinopodes decreased in 1st group, but not in 2nd group. ER and PR expression levels in the glandular component decreased in all patients, being consistently higher in 1st group. An increase in proinflammatory markers was observed only in 1st group. Conclusion. UF and UAE can disturb morpho-functional state of the endometrium. The impact assessment should be made taking into account the topographic and anatomical location of the myomatous node.