Association of endometrial pathologies with infertility and malignant potential in pre- and postmenopausal women—a systematic review

OBJECTIVES: The objective of this systematic review is to investigate and synthesize the existing literature on the association of endometrial pathologies with infertility and malignant potential in premenopausal and postmenopausal women, with a specific emphasis on evaluating the diagnostic utility of transvaginal ultrasound. METHODS: Google Scholar and PubMed were searched systematically, in addition to manual searches, to compile the literature review. We came across 50 papers; only 35 made it past the initial screening. Twenty-four items were left out because they were either non-English references, needed copyright clearance, or required a subscription. The final review had a total of 15 papers. Only original research papers and systematic reviews that sonographically examined the endometrial pathologies and papers that mentioned infertility risk and malignant potential of these diseases in pre- and postmenopausal women were included. RESULTS: The results underscore the complex interplay between endometrial pathologies, infertility, and malignant potential, providing valuable insights for clinicians and researchers in the field. CONCLUSIONS: Postmenopausal women are at increased risk of malignant potential as compared to premenopausal women. The malignant potential of endometrial hyperplasia is exceptionally high, while it is lower in the case of endometrial polyps and submucosal uterine leiomyomas. Some endometrial lesions, such as endometrial polyps, submucosal uterine leiomyomas and endometritis, are reportedly strongly associated with infertility. ADVANCES IN KNOWLEDGE: This review adds clarity to how different endometrial pathologies relate to infertility and cancer risk, and it underscores the value of transvaginal ultrasound in assessing these conditions across various reproductive stages.