International Expert Consensus Statement on Chronic Endometritis: A Comprehensive Literature Review and Modified
Kotaro Kitaya1,2, Keiji Kuroda1,3,4, Seung Chik Jwa1,5
1The Japan Society of Reproductive Medicine Female Reproductive Tract Special Interest Group on Chronic Endometritis Tokyo Japan.
Reproductive Medicine and Biology
|June 15, 2026
Summary
International experts reached consensus on chronic endometritis (CE) diagnosis and treatment. Key findings include diagnostic criteria and management strategies for this gynecologic condition.
Area of Science:
- Reproductive Medicine
- Gynecology
- Pathology
Background:
- Chronic endometritis (CE) diagnosis and management lack standardized international guidelines.
- Existing evidence on CE is fragmented, necessitating expert consensus.
Purpose of the Study:
- To establish international expert consensus statements on chronic endometritis (CE).
- To provide a foundation for diagnostic criteria and clinical guidelines for CE.
Main Methods:
- A comprehensive literature review was conducted.
- A modified Delphi approach involving 31 international experts was employed.
- Two rounds of e-Delphi questionnaires were used to evaluate derived statements.
Main Results:
- Consensus was reached on 23 out of 24 statements covering CE epidemiology, symptomatology, etiology, microbiology, diagnosis, and treatment.
- A histopathologic threshold of ≥5 endometrial stromal plasma cells/10 high-power fields for CE diagnosis achieved 81% agreement.
- Key areas of consensus include risk factors, subtle clinical manifestations, diagnostic methods (histopathology, hysteroscopy, microbiome analysis), and treatment options (antibiotics, surgery).
Conclusions:
- The consensus statements offer a real-world clinical perspective on CE.
- These statements can serve as a basis for developing standardized diagnostic criteria and clinical guidelines for chronic endometritis.
- Expert consensus addresses critical aspects of CE, from diagnosis to treatment, potentially improving patient outcomes.
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