Work

Effects on Gynecologic Symptoms and Infertility in the Treatment of Endometrial Osseous Metaplasia: A Systematic Review of Case Reports and Small Series

Year: 2026

Type: review

Abstract: OBJECTIVE: To systematically review the literature on endometrial osseous metaplasia, its clinical presentation, diagnostic approaches, and the efficacy of uterine-preserving treatments in restoring fertility and alleviating symptoms. This review was registered on PROSPERO (CRD42023387361). DATA SOURCES: A comprehensive search of PubMed, OVID and EMBASE was conducted from inception to February 2025. STUDY SELECTION: Included studies reported on the diagnosis of endometrial osseous metaplasia, uterine-preserving treatments, and fertility or gynecology outcomes. The search yielded 1836 studies, narrowed to 153 articles, of which 37 were included (26 case reports, 8 case series, 2 retrospective and 1 prospective study). DATA EXTRACTION/SYNTHESIS: Across 37 studies, 128 patients were identified. The mean age was 34.4 years, with 64.1% having a history of abortion or miscarriage. Among 83 patients with infertility, 10.8% had primary and 57.8% had secondary infertility. All underwent hysteroscopic resection; 18.0% also had dilatation and curettage, and one received endometrial ablation. Of 60 patients pursuing fertility after treatment, 78.3% conceived: 59.6% spontaneously, 10.6% through assisted reproductive technology, and 4.2% with ovulation induction. The mean time to conception was 6.7 months (range 1-36). Symptom resolution occurred in 83.3% of patients, including improvements in abnormal bleeding, dysmenorrhea, and pelvic pain. Risk of bias varied (scores 2-7), with retrospective cohort studies demonstrating higher methodological quality. CONCLUSION: Hysteroscopic resection appears to be a promising fertility-sparing treatment for endometrial osseous metaplasia based on case reports and small case series. However, robust data on efficacy and long-term outcomes are lacking. Given its association with prior pregnancy loss and endometrial trauma, greater clinical awareness and early management may improve reproductive outcomes. Further prospective studies are needed to clarify long-term fertility and recurrence post-treatment.

Source: Journal of Obstetrics and Gynaecology Canada

DOI: 10.1016/j.jogc.2026.103240

Authors: Salwa Farooqi, Praniya Elangainesan, Vrati M. Mehra, Ally Murji

Institutions: University of Toronto, Mount Sinai Hospital, Trillium Health Centre

Language: English

Topic: Gynecological conditions and treatments

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,100