Inflammation: A link between endometriosis and preterm birth

Obstetrics and Gynecology, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
Fertility and sterility (Impact Factor: 4.59). 05/2012; 98(1):36-40. DOI: 10.1016/j.fertnstert.2012.04.051
Source: PubMed


Endometriosis is a chronic inflammatory disease affecting women's health. Pain and infertility are the major symptoms caused by a hormonal/immunological dysfunction, which causes an endometrial impairment. The same pathogenetic mechanisms are also associated with preterm birth: hormones, cytokines, neurohormones, and growth factors interact in modulating extracellular matrix and prostaglandin secretion, thus activating the inflammatory process in placental membranes and myometrium. An overlap of molecules and mechanisms may explain the evidence that preterm birth is a common outcome in pregnant patients with endometriosis.

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    • "The presence of endometriosis induces a chronic inflammatory condition capable of influencing pregnancy outcome [1] and, although the condition can be asymptomatic, according to a recent statement by the American Society for Reproductive Medicine "typically presents with pelvic pain, infertility, or an adnexal mass, and may require surgery" [2]. The prevalence of endometriosis in women undergoing laparoscopy for evaluation of infertility has been estimated between 9 and 50% and its presence is 6 to 8 times more frequent in infertile women [3]. "
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    ABSTRACT: To improve the still fragmented understanding of endometriosis a life-cycle approach is adopted that revealed unexpected aspects of the natural history of the disease throughout a woman's life. Three age related stages of endometriosis are distinguished. In premenarcheal and adolescent endometriosis two types can be distinguished: a "classic form", namely that can occur before the menarche and a "congenital obstructive form" that is caused by uterine anomaly and outflow obstruction. The lesions include superficial peritoneal implants, but adhesions and endometrioma can also occur. It is suggested that premenarcheal and possibly adolescent endometriosis develop by activation of resting stem cells shed at the time of neonatal retrograde uterine bleeding. In the adult endometriosis can be related to uterine preconditioning by cyclic menstruations acting as a priming mechanism for deep placentation. In adult life the typical lesions are peritoneal, ovarian and deep or adenomyotic endometriosis. More recently, endometriosis has been associated with endometrial dysfunction and myometrial junctional zone hyperplasia. These uterine changes can be linked with some major obstetrical syndromes. In the post-menopause, endometriosis can develop or be re-activated both in the presence or absence of exogenous estrogens and can spread to a variety of organs and structures causing constrictive lesions.
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