Is adenomyosis the neglected phenotype of an endomyometrial dysfunction syndrome? (original) (raw)
Related papers
Human Reproduction, 2005
BACKGROUND: The hypothesis is tested that there is a strong association between endometriosis and adenomyosis and that adenomyosis plays a role in causing infertility in women with endometriosis. METHODS. Magnetic resonance imaging of the uteri was performed in 160 women with and 67 women without endometriosis. The findings were correlated with the stage of the disease, the age of the women and the sperm count parameters of the respective partners. RESULTS: The posterior junctional zone (PJZ) was significantly thicker in women with endometriosis than in those without the disease (P < 0.001). There was a positive correlation of the diameter of the PJZ with the stage of the disease and the age of the patients. The PJZ was thicker in patients with endometriosis with fertile than in patients with subfertile partners. The prevalence of adenomyotic lesions in all 160 women with endometriosis was 79%. In women with endometriosis below an age of 36 years and fertile partners, the prevalence of adenomyosis was 90% (P < 0.01) CONCLUSIONS: With a prevalence of up to 90%, uterine adenomyosis is significantly associated with pelvic endometriosis and constitutes an important factor of sterility in endometriosis presumably by impairing uterine sperm transport.
Endometriosis and adenomyosis - A shared pathophysiology
Giornale Italiano di Ostetricia e Ginecologia
The major authors of the last century described endometriosis as ectopic endometrial lesions occurring both in the uterus and in the peritoneal cavity, and the lesions were considered as variants of the same disease process. In the 1920s a theory had been put forward that, although severely and chronically challenged, resulted in the clear cut separation of the two entities. A new understanding of the disease process, however, enables to reunify these two disease entities and to integrate them into a new nosological concept. Circumstantial evidence suggests that endometriosis and adenomyosis share a similar pathophysiology and are caused by trauma. In the spontaneously developing disease, chronic uterine peristaltic activity or phases of hyperperistalsis induce, at the endometrial-myometrial interface near the fundo-cornual raphe, microtraumata with the activation of the basal and general mechanism of "tissue injury and repair" (TIAR). This results in the local production of estrogens. With ongoing peristaltic activity, such sites will accumulate and the increasingly produced estrogens interfere via paracrine mode of action with the endocrine ovarian control over uterine peristaltic activity, resulting in permanent hyperperistalsis and a self-perpetuation of the disease process. Overt auto-traumatization of the uterus, with dislocation of fragments of basal endometrium into the peritoneal cavity and infiltration of basal endometrium into the depth of the myometrial wall, ensues. In most cases of endometriosis/adeno-myosis, a causal event early in the reproductive period of life must be postulated leading to uterine hyperperistalsis. In late premenopausal adenomyosis such overt event might not have occurred. However, as indicated by the high prevalence of the disease, it appears to be unavoidable that, with time, chronic normoperistalsis throughout the reproductive period of life may result in events that accumulate to the same extent of microtraumatizations. With the activation of the TIAR mechanism, followed by infiltrative growth and chronic inflammation, endometriosis/adenomyosis of the younger woman and premenopausal adenomyosis share in principal the same pathophysiology. In conclusion, endometriosis and adenomyosis result from the physiological mechanism of 'tissue injury and repair' (TIAR) involving local estrogen production in an estrogen-sensitive environment normally controlled by the ovary. It appears that many of the altered endometrial molecular markers described in the context of endometriosis are the consequence rather than the cause(s) of the disease.
Histopathological pattern of endometrium in Adenomyosis
Innovative publication, 2016
Objective: To study the histopathological pattern of endometrium and associated pathological conditions in patients who had abnormal uterine bleeding due to adenomyosis. Material and Methods: This was a study done at M.S. Ramaiah medical college and teaching hospital,Bangalore on 44 patients who underwent hysterectomy due to Abnormal uterine bleeding with adenomyosis from Dec 2013 to Dec 2015. All the quantitative variables were expressed as mean and qualitative variables as percentages. Results: The age of the patients who had adenomyosis ranged from 34 to 65 years, majority (50%) were in the age group of 41-50 years. The commonest histopathological pattern found was proliferative endometrium (n=26, 59.09%). Conclusion: Adenomyosis contributes to a large proportion of patients who present with abnormal uterine bleeding. The associated histopathology varies from proliferative endometrium to endometrial hyperplasia. Estrogen may be a risk factor as it is associated with fibroid and endometrial hyperplasia.
Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis
Fertility and Sterility, 2018
Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound. (Fertil Steril Ò 2018;109:380-8. Ó2018 by American Society for Reproductive Medicine.
Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility
Journal of Clinical Medicine, 2021
We compared the prevalence of ultrasound signs of adenomyosis in women with endometriosis who underwent surgery to those who were managed conservatively. This was a retrospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demographics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was higher in the study group. Women in the s...
How to evaluate adenomyosis in patients affected by endometriosis?
Minimally invasive surgery, 2014
Objective. The aim of the study is to evaluate adenomyosis in patients undergoing surgery for different type of endometriosis. It is an observational study including women with preoperative ultrasound diagnosis of adenomyosis. Demographic data and symptoms were recorded (age, body mass index, parity, history of previous surgery, dysmenorrhea, dyspareunia, dyschezia, dysuria, and abnormal uterine bleeding). Moreover a particular endometrial shape "question mark sign" linked to the presence of adenomyosis was assessed. Results. From 217 patients with ultrasound diagnosis of adenomyosis, we found 73 with ovarian histological confirmation of endometriosis, 92 with deep infiltrating endometriosis, and 52 patients who underwent surgery for infertility. Women with adenomyosis alone represented the oldest group of patients (37.8 ± 5.18 years, P = 0.02). Deep endometriosis patients were nulliparous more frequently (P < 0.0001), had history of previous surgery (P = 0.004), and co...
Histopathological Association of Adenomyosis with Various Gynaecological Pathologies
Annals of Pathology and Laboratory Medicine, 2020
Objective: To study the histopathological pattern of endometrium and associated pathological conditions in patients presenting with abnormal uterine bleeding due to adenomyosis. Material and Methods: The study was conducted at Maulana Azad Medical College, New Delhi and included 87 patients who underwent hysterectomy and were diagnosed with adenomyosis from Jan 2017 to Dec 2019. These cases were subsequently reviewed for presenting symptoms of adenomyosis and correlated with histomorphological features and associated comorbidities. The quantitative variables were expressed as mean and qualitative variables as percentages. Results and Conclusion: The age of the patients who had adenomyosis ranged from 25 to 65 years, majority were in the age group of 40-50 years. Abnormal uterine bleeding was the most common symptom. The associated histopathological examination reveals pattern of endometrium from proliferative endometrium to endometrial hyperplasia. Estrogen may be a risk factor as it is associated with fibroid and endometrial hyperplasia.
Adenomyosis and endometriosis have a common origin
The Journal of Obstetrics and Gynecology of India, 2011
The presence of epithelial cells in the peritoneal cavity and within the myometrium was described during the second part of the 19th century and was given the name "adenomyoma". Then, with the identification of peritoneal endometriosis in the 1920s, adenomyosis became a separate nosological entity. For decades, the two abnormalities have been considered separate benign proliferative conditions of the female reproductive tract with a different clinical profile. More recently, however, evidence has been accumulated indicating that these two diseases have in common an endometrial dysfunction involving both eutopic and heterotopic endometrium causing a reaction in the inner myometrium (the so-called myometrium junctional zone (JZ)). It therefore seems that adenomyosis and endometriosis share a common origin in an abnormal eutopic endometrium and myometrium JZ. It is therefore no surprise that both conditions are associated with obstetrical disorders, such as spontaneous preterm delivery and premature preterm rupture of the membranes, which may have roots in a disturbed decidualization and placentation process.