The human endometrium is a unique tissue undergoing important changes through the menstrual cycle. Under the exposure of different risk factors in a woman’s lifetime, normal endometrial tissue can give rise to multiple pathologic conditions, including endometriosis and endometrial cancer. Etiology and pathophysiologic changes behind such conditions remain largely unclear. This review summarizes the current knowledge of the pathophysiology of endometriosis and its potential role in the development of endometrial cancer from a molecular perspective. A better understanding of the molecular basis of endometriosis and its role in the development of endometrial pathology will improve the approach to clinical management.
Although it is clear that infertility leads to heightened stress for patients, the impact of depressed mood and anxiety on treatment outcome is inconsistently reported. The aim of this study was to evaluate the effect of stress, depression and anxiety on in vitro fertilization (IVF) outcomes in Kazakhstani public assisted reproductive technology (ART) clinics. The prospective cohort study was performed between June 2019 and September 2020 using questionnaires to assess psychological stress, depressed mood and anxiety in women referred to IVF clinics in two public clinical centers in Kazakhstan, Nur-Sultan and Aktobe. Our study sample comprised 142 women with the average age of 33.9 ± 4.9 years, and infertility duration 6.0 ± 3.5 years. More than half of respondents had Center for Epidemiological Studies Depression Scale (CES-D) scores higher than 16, indicating their risk of developing clinical depression. Ninety-one percent of women from Aktobe city were at risk for clinical depression (p < 0.001). Aktobe city respondents had higher stress subscale scores and anxiety scale scores (p < 0.001) than Nur-Sultan respondents. Statistical analysis showed that IVF outcome was not significantly associated with depression and stress, while the higher anxiety scale scores were negatively associated with clinical pregnancy after IVF.
Endometrial cancer is the most common gynecologic cancer in developed countries. The most prevalent, however not pathognomonic symptom of the disease is abnormal uterine bleeding. The diagnosis of endometrial cancer is based on the histologic results of endometrial sampling. Endometrial biopsy could be obtained using different modalities: hysteroscopy-directed endometrial biopsy, uterine curettage or office endometrial biopsy. Outpatient endometrial biopsy using different devices for the evaluation of abnormal uterine bleeding is gaining popularity. The most popular office-based device for endometrial sampling procedure is the Pipelle device. Currently, Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine bleeding and/or postmenopausal bleeding. The method became very useful due to easiness and simplicity of the procedure, availability of a device, as well as high sensitivity in detecting endometrial cancer. Many studies compared the validity and accuracy of Pipelle biopsy with dilation and curettage in the detection of various endometrial pathologies. Published results state that Pipelle biopsy and uterine curettage are almost equally reliable in the evaluation of endometrial pathologies. Moreover, Pipelle biopsy appears more beneficial as it does not require hospital admission and anaesthesia. However, it is proven the Pipelle technique has a limited capacity to identify endometrial polyps, and some authors, based on their study, claim that dilation and curettage is a more reliable method in terms of correlation with the final histological results. In addition, there are many factors affecting the efficiency of the endometrial biopsy. Failure to get samples that are adequate for histological examination is one of the problems associated with Pipelle sampling. The above mentioned contradictory conclusions by different researchers and lack of guidance to avoid inadequate sampling present the demand for further studies on the comparison of Pipelle biopsy and uterine curettage efficiency and accuracy.
Preterm labor is defined as a birth before 37 weeks of gestation and occurs in 5–20% of pregnancies. Preterm labor, as multifactorial entity associated with a high risk of neonatal morbidity and mortality, is influenced by maternal, fetal and environmental factors. Microbiological studies suggest that infectious pathogens may account for 25–40% of preterm birth. Infections of different sites, like genital, urinary tract infections, and pneumonia, are linked to the preterm labor. The most recent epidemiological studies consistently report that maternal periodontal disease is associated with preterm delivery, as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes. On the other hand, some previously published papers found periodontal bacteria in placentas of term pregnancies. In spite of a huge research done on the topic, both experimental and clinical, there are many controversial opinions about the role of periodontal infections in preterm birth. Thus, this comprehensive review addresses this very important topic and evaluates novel strategies of preventive and therapeutic approaches.
Endometriosis is a chronic benign gynecological disease with symptoms that can severely impact quality of life and well-being. Women affected by endometriotic ovarian cyst could have associated infertility problems. Infertility affects 30% to 50% of women with endometriosis. Women with endometriosis are at risk of decreased ovarian reserve, due to the disease pathophysiologic mechanisms. Generally, infertility management include surgical procedure (usually with minimally invasive approach) and ovulation induction with intrauterine insemination or in vitro fertilization. Fertility preservation technologies also include oocyte or embryo freezing and ovarian tissue cryopreservation. Approach to patients with endometriotic cysts still remains controversial, and a multidisciplinary approach is a key factor to achieve the best outcome with appropriate patient counselling. Such management by a multidisciplinary team is a key factor in achieving the successful outcome.
Adenocarcinoma of the uterine cervix (CA) accounts for 15-25% of all the cervical cancer (CC) cases; the proportion of CA in the world has been increasing over the last decades particularly in youn...