{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:52:21Z","timestamp":1787028741985,"version":"build-2736575974"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>(1) Background: Endometriosis and chronic endometritis (CE) are pathologies that are positively correlated and have similar paracrine and immunological alterations. This leads us to wonder whether their interrelationship plays a role in the etiopathogenesis or progression of endometriosis. The purpose of this study is to evaluate whether patients with endometriosis and CE have a more advanced stage of the disease, higher rates of pain, a poorer response to treatment, and a greater association with other pathologies compared to women with endometriosis without CE. (2) Methods: This is a cross-sectional pilot design study of 37 women with endometriosis who underwent endometrial aspiration for the diagnosis of CE and were followed up at the Puerta de Hierro Hospital. (3) Results: All patients with CE in this study had adenomyosis (p = 0.004). There was a relatively homogeneous distribution of CE in the different endometriosis phenotypes. The group of patients with endometriosis and CE indicated higher rates of pain during ovulation and less pain during defecation and sexual intercourse. (4) Conclusions: A high prevalence of CE was observed in patients with endometriosis, as well as a trend suggesting a relationship between CE and adenomyosis that should be studied. The following article attempts to reflect a link found between endometriosis and chronic endometritis, which would be important when prescribing personalized medicine, as it forces us to look for a specific disease in a specific patient profile.<\/jats:p>","DOI":"10.3390\/jpm16020073","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:03:29Z","timestamp":1770113009000},"page":"73","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Role of Chronic Endometritis in Endometriosis: A Personalized Diagnostic Tool?"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3172-1690","authenticated-orcid":false,"given":"Mar\u00eda","family":"Luna Arana","sequence":"first","affiliation":[{"name":"Puerta de Hierro University Hospital, Autonomous University of Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2534-1007","authenticated-orcid":false,"given":"Augusto","family":"Pereira S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Puerta de Hierro University Hospital, Autonomous University of Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Vaquero Arg\u00fcello","sequence":"additional","affiliation":[{"name":"Puerta de Hierro University Hospital, Autonomous University of Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6314-5408","authenticated-orcid":false,"given":"Eva","family":"Tejerina Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Puerta de Hierro University Hospital, Autonomous University of Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagros","family":"Alonso-Iniesta","sequence":"additional","affiliation":[{"name":"Puerta de Hierro University Hospital, Autonomous University of Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4560-453X","authenticated-orcid":false,"given":"Tirso","family":"P\u00e9rez Medina","sequence":"additional","affiliation":[{"name":"Puerta de Hierro University Hospital, Autonomous University of Madrid, 28049 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1093\/humrep\/der341","article-title":"The Reliability of the Histological Diagnosis of Endometritis in Asymptomatic IVF Cases: A Multicenter Observer Study","volume":"27","author":"Kasius","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.fertnstert.2007.03.074","article-title":"Chronic Endometritis: Correlation among Hysteroscopic, Histologic, and Bacteriologic Findings in a Prospective Trial with 2190 Consecutive Office Hysteroscopies","volume":"89","author":"Cicinelli","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/humrep\/deu292","article-title":"Prevalence of Chronic Endometritis in Repeated Unexplained Implantation Failure and the IVF Success Rate after Antibiotic Therapy","volume":"30","author":"Cicinelli","year":"2015","journal-title":"Hum. Reprod. Oxf. Engl."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/j.1600-0897.2011.01051.x","article-title":"Immunohistochemistrical and Clinicopathological Characterization of Chronic Endometritis","volume":"66","author":"Kitaya","year":"2011","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0889-8545(05)70302-8","article-title":"Epidemiology of Endometriosis","volume":"24","author":"Eskenazi","year":"1997","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kitaya, K., and Yasuo, T. (2023). Commonalities and Disparities between Endometriosis and Chronic Endometritis: Therapeutic Potential of Novel Antibiotic Treatment Strategy against Ectopic Endometrium. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24032059"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Takebayashi, A., Kimura, F., Kishi, Y., Ishida, M., Takahashi, A., Yamanaka, A., Takahashi, K., Suginami, H., and Murakami, T. (2014). The Association between Endometriosis and Chronic Endometritis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088354"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s12978-024-01897-9","article-title":"How Does Chronic Endometritis Influence Pregnancy Outcomes in Endometriosis Associated Infertility? A Retrospective Cohort Study","volume":"21","author":"Lin","year":"2024","journal-title":"Reprod. Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Li, J., Wei, J., Chen, S., Wang, X., Chen, J., Zeng, D., and Fan, L. (2024). Prevalence and Risk Factors for Chronic Endometritis in Patients with Adenomyosis and Infertility: A Retrospective Cohort Study. BMC Womens Health, 24.","DOI":"10.1186\/s12905-024-03245-2"},{"key":"ref_10","first-page":"93","article-title":"Metastatic or Embolic Endometriosis, Due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation","volume":"3","author":"Sampson","year":"1927","journal-title":"Am. J. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1002\/rmb2.12083","article-title":"Bacterial Contamination Hypothesis: A New Concept in Endometriosis","volume":"17","author":"Khan","year":"2018","journal-title":"Reprod. Med. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2860","DOI":"10.1016\/j.fertnstert.2010.04.053","article-title":"Escherichia coli Contamination of Menstrual Blood and Effect of Bacterial Endotoxin on Endometriosis","volume":"94","author":"Khan","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrendo.2013.255","article-title":"Endometriosis: Pathogenesis and Treatment","volume":"10","author":"Vercellini","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/uog.15955","article-title":"Systematic Approach to Sonographic Evaluation of the Pelvis in Women with Suspected Endometriosis, Including Terms, Definitions and Measurements: A Consensus Opinion from the International Deep Endometriosis Analysis (IDEA) Group","volume":"48","author":"Guerriero","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","first-page":"217","article-title":"Chronic Endometritis","volume":"52","author":"Michels","year":"1995","journal-title":"Am. Fam. Physician"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e13369","DOI":"10.1111\/aji.13369","article-title":"Diagnosis of Chronic Endometritis: How Many CD138+ Cells\/HPF in Endometrial Stroma Affect Pregnancy Outcome of Infertile Women?","volume":"85","author":"Li","year":"2021","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Vitagliano, A., Lagan\u00e0, A.S., Ziegler, D.D., Cicinelli, R., Santarsiero, C.M., Buzzaccarini, G., Chiantera, V., Cicinelli, E., Marinaccio, M., and Vitagliano, A. (2022). Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome\u2014A Systematic Review and Meta-Analysis. Diagnostics, 12.","DOI":"10.3390\/diagnostics12092250"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/uog.19096","article-title":"Sonographic Classification and Reporting System for Diagnosing Adenomyosis","volume":"53","author":"Dueholm","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, Definitions and Measurements to Describe Sonographic Features of Myometrium and Uterine Masses: A Consensus Opinion from the Morphological Uterus Sonographic Assessment (MUSA) Group","volume":"46","author":"Dueholm","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_20","unstructured":"R Core Team (2021). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1467-9868.2008.00700.x","article-title":"Approximate Bayesian inference for latent Gaussian models using integrated nested Laplace approximations (with discussion)","volume":"71","author":"Rue","year":"2009","journal-title":"J. R. Stat. Soc. Ser. B"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1001\/jama.2025.2975","article-title":"Endometriosis: A Review","volume":"334","author":"Mackenzie","year":"2025","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1159\/000223819","article-title":"Poor Reliability of Vaginal and Endocervical Cultures for Evaluating Microbiology of Endometrial Cavity in Women with Chronic Endometritis","volume":"68","author":"Cicinelli","year":"2009","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Santoro, A., Travaglino, A., Inzani, F., Angelico, G., Raffone, A., Maruotti, G.M., Straccia, P., Arciuolo, D., Castri, F., and D\u2019Alessandris, N. (2023). The Role of Plasma Cells as a Marker of Chronic Endometritis: A Systematic Review and Meta-Analysis. Biomedicines, 11.","DOI":"10.3390\/biomedicines11061714"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.molmed.2018.07.004","article-title":"The Immunopathophysiology of Endometriosis","volume":"24","author":"Symons","year":"2018","journal-title":"Trends Mol. Med."},{"key":"ref_26","first-page":"151","article-title":"Retrograde Menstruation in Healthy Women and in Patients with Endometriosis","volume":"64","author":"Halme","year":"1984","journal-title":"Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1056\/NEJMra0804690","article-title":"Endometriosis","volume":"360","author":"Bulun","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0015-0282(01)01816-7","article-title":"Role of Cytokines in Endometriosis","volume":"76","author":"Harada","year":"2001","journal-title":"Fertil. Steril."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1159\/000049420","article-title":"Role of Cytokines in Endometriosis-Associated Infertility","volume":"53","author":"Iwabe","year":"2002","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.fertnstert.2013.09.041","article-title":"Interleukin-6, Interleukin-1\u03b2, and Tumor Necrosis Factor \u03b1 in Menstrual Effluents as Biomarkers of Chronic Endometritis","volume":"101","author":"Tortorella","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.fertnstert.2018.04.012","article-title":"Endometritis: New Time, New Concepts","volume":"110","author":"Kitaya","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ii, J.A.M., Hayashi, K., Ii, J.A.M., and Hayashi, K. (2022). Progesterone Actions and Resistance in Gynecological Disorders. Cells, 11.","DOI":"10.3390\/cells11040647"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.fertnstert.2015.01.007","article-title":"Altered uterine contractility in women with chronic endometritis","volume":"103","author":"Pinto","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.rbmo.2021.02.003","article-title":"Impact of chronic endometritis in infertility: A SWOT analysis","volume":"42","author":"Fabregues","year":"2021","journal-title":"Reprod. Biomed. Online"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/jog.13937","article-title":"Review: Chronic Endometritis and Its Effect on Reproduction","volume":"45","author":"Kimura","year":"2019","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.fertnstert.2017.05.016","article-title":"Higher Prevalence of Chronic Endometritis in Women with Endometriosis: A Possible Etiopathogenetic Link","volume":"108","author":"Cicinelli","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Martire, F.G., Costantini, E., D\u2019Abate, C., Schettini, G., Sorrenti, G., Centini, G., Zupi, E., Lazzeri, L., Martire, F.G., and Costantini, E. (2025). Endometriosis and Adenomyosis: From Pathogenesis to Follow-Up. Curr. Issues Mol. Biol., 47.","DOI":"10.3390\/cimb47050298"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e250016","DOI":"10.1530\/RAF-25-0016","article-title":"Chronic Endometritis Diagnosis and Fertility Outcomes: An Old Unresolved Question","volume":"6","author":"Ilic","year":"2025","journal-title":"Reprod. Fertil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"602.e1","DOI":"10.1016\/j.ajog.2018.02.012","article-title":"The Diagnosis of Chronic Endometritis in Infertile Asymptomatic Women: A Comparative Study of Histology, Microbial Cultures, Hysteroscopy, and Molecular Microbiology","volume":"218","author":"Moreno","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.fertnstert.2022.07.011","article-title":"The menstrual cycle phase impacts the detection of plasma cells and the diagnosis of chronic endometritis in endometrial biopsy specimens","volume":"118","author":"Ryan","year":"2022","journal-title":"Fertil. Steril."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s43032-025-01785-y","article-title":"Chronic Endometritis and Endometriosis: Two Sides of the Same Coin?","volume":"32","author":"Kalaitzopoulos","year":"2025","journal-title":"Reprod. Sci."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/2\/73\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:19:14Z","timestamp":1770113954000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/16\/2\/73"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,31]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jpm16020073"],"URL":"https:\/\/doi.org\/10.3390\/jpm16020073","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,31]]}}}