ENDOMETRIAL HYPERPLASIA AND ITS ASSOCIATION WITH SERUM ESTROGEN LEVELS IN WOMEN WITH RECURRENT MISCARRIAGE AND THE ROLE OF CORTICOSTEROIDS

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.