ENDOMETRIAL HYPERPLASIA AND ITS ASSOCIATION WITH SERUM ESTROGEN LEVELS IN WOMEN WITH RECURRENT MISCARRIAGE AND THE ROLE OF CORTICOSTEROIDS
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Keywords
Endometrial hyperplasia, Estradiol, Recurrent miscarriage, Corticosteroid therapy, Pregnancy outcome
Abstract
Recurrent miscarriage is a distressing condition affecting many women of reproductive age, with endometrial pathology and hormonal imbalance being important contributors. Elevated serum estradiol may promote endometrial hyperplasia and impair receptivity, increasing the risk of pregnancy loss. Corticosteroid therapy has been proposed as a potential intervention to improve outcomes in selected cases.
Objective
To evaluate the association between endometrial hyperplasia and serum estradiol levels in women with recurrent miscarriage and to determine the impact of corticosteroid therapy on subsequent pregnancy outcomes.
Methods
This prospective observational study was conducted at Women Medical and Dental College, Abbottabad, from January 2023 to January 2024. A total of 73 women with a history of recurrent miscarriage were enrolled. Endometrial biopsy was performed and classified into histological subtypes. Serum estradiol levels were measured using chemiluminescent immunoassay. Women with endometrial abnormalities were offered low-dose corticosteroid therapy, and pregnancy outcomes were recorded.
Results
Endometrial hyperplasia was identified in 60.3% of participants, with complex hyperplasia being the most frequent subtype. Women with hyperplasia had significantly higher mean estradiol levels compared to those without hyperplasia (268.5 ± 42.3 pg/mL vs. 219.7 ± 38.9 pg/mL, p=0.03). Among women who conceived after corticosteroid therapy, those achieving live births had lower estradiol levels compared to those with persistent miscarriage (230.6 ± 35.4 pg/mL vs. 276.2 ± 40.7 pg/mL, p=0.02). Corticosteroid therapy improved live birth rates (65.6% vs. 29.3%, p=0.002) and reduced miscarriage recurrence (28.1% vs. 61.0%, p=0.001). Side effects such as weight gain and glucose intolerance were observed in a minority of cases.
Conclusion
Endometrial hyperplasia and elevated serum estradiol are significant risk factors for recurrent miscarriage. Corticosteroid therapy appears to enhance live birth rates in selected women, although careful monitoring is necessary. Early hormonal and endometrial assessment may guide individualized management strategies for recurrent pregnancy loss.
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Dr Chaman Ara
Assistant Professor, Department of Obstetrics and Gynaecology, Women Medical and Dental College, Abbottabad, Pakistan
Dr Hina Zuhra
Assistant Professor, Department of Obstetrics and Gynaecology, KMU Institute of Medical Sciences/Liaqat Memorial Hospital, Kohat, Pakistan
Dr Aiman Khan
MPhil Scholar, Department of Histopathology, Khyber Medical University, Peshawar, Pakistan
Dr Nadia Jabeen
Associate Professor, Department of Obstetrics and Gynaecology, Rawal Institute of Health Sciences, Islamabad, Pakistan
Dr Salma Rashid Khan
Assistant Professor, Department of Pharmacology, Women Medical and Dental College, Abbottabad, Pakistan
Dr Hamayun Mumtaz
Assistant Professor, Department of Chemical Pathology, Poonch Medical College, Rawalakot, Pakistan