Local hemostasis disorders underlying endometric pathology

Introduction. Hemostasis is an equilibrium system that performs 2 bidirectional tasks: on the one hand, it prevents bleeding development, whereas on the other hand, it counters thrombogenesis. Shifting the balance leads to development of various complications, and also serves as a key link in the pathogenesis of a number of diseases. Currently, the issue of changing the state of local endometrial hemostasis in various pathologies is of high priority. Unfortunately, publications available on this problem are limited.

Aim: to conduct a literature search and systematize the data analysis to expand understanding regarding a role of local hemostasis disorders in formation of endometrial pathology.

Materials and Methods. There has been performed a systematic analysis of full-text scientific reviews and original articles published in English and Russian in the modern literature. The review includes the 1995-2020 data published in the international abstract and bibliographic databases eLibrary, Google Scholar, Web of Science, Scopus and PubMed/MEDLINE.

Results. Hemostatic changes in the endometrium that occur under the influence of estrogens and progesterone, and create a local hemostatic environment, which disturbance contributes to emergence of various endometrial pathologies, are described. It was found that for the physiological course of pregnancy, complex changes in the local hemostasis are necessary, which are aimed at facilitating the processes of chorionic invasion and maintaining metabolic processes in the mother-fetus interface, whereas alteration of the aforementioned processes contributes to development of abnormal chorionic invasion as the basis for development of insufficient placental function, preeclampsia (PE), and pregnancy termination. Moreover, there have been summarized the data on key changes in the state of local endometrial hemostasis that play a role in the pathogenesis of endometriosis, as well as underlying abnormal uterine bleeding (AUB).

Conclusion. Current research publications provide sparse evidence that the state of the local hemostasis in the endometrium is an important aspect of the physiological course of the menstrual cycle, as well as formation of endometrial pathology. In this review, it is shown that local hemostasis is inextricably linked with the state of the systemic hemostasis, but at the same time, its functioning depends on the level of hormones estrogens and progesterone. Impaired function of local endometrial hemostasis is an important aspect of the pathogenesis of miscarriage, as well as conditions such as PE, endometriosis, AUB.

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