Current facts constituting an understanding of the nature of adenomyosis

Abstract

Adenomyosis seems to be the most widespread coexistent pathology included under the umbrella of common benign disorders of the human uterus. The incidence of adenomyosis is under discussion since different imaging criteria are used. In the majority of cases, prevalence is determined among women with uterine fibroids and endometriosis or severe gynecological symptoms. This common benign pathology is asymptomatic in 1/3 of cases. Up to 50% of women with infertility are affected by adenomyosis. It seems to be an important risk factor for spontaneous pre-term delivery and pre-term premature rupture of the membranes. Nowadays, the etiology of adenomyosis is still unclear and requires deeper investigation. This review summarizes the aspects of prevalence, coexistence , risk factors, classification, mechanisms of pathogenesis, genes and immunological features, main histological features, animal models, and clinical manifestation of adenomyosis. It might facilitate understanding of the independent nature of such a dual enigma as adenomyosis.

Risk factors for postoperative recurrence of ovarian endometriosis: long-term follow-up of 358 women

“…We observed a statistically significant correlation between pelvic pain and the presence of adenomyosis (Fig. 3), in agreement with the previously reported results [27, 28]. Dysmenorrhea is a risk factor in the deep adenomyotic process with a high density of endometrial glands in the myometrium [29].…”

Keeping an Eye on Perimenopausal and Postmenopausal Endometriosis

“…In our findings, we noticed a greater incidence of uterine leiomyomata in the perimenopausal group, although adenomyosis was prominent in postmenopausal patients. Adenomyosis appears during the reproductive period; thus, our findings are not in agreement with the literature—it is believed that adenomyosis is a pre-existing condition that can diagnosed via surgery after menopause [22].…”

Animal Models of Adenomyosis

“…Therapies that affect steroid hormone levels or downstream signaling such as progestins, gonadotropin-releasing hormone (GnRH) agonists, SERMs, and selective progesterone receptor modulators (SPRMs) are commonly used or experimentally tried medical treatments for gynecological diseases such as endometriosis and adenomyosis. 2,3,70,71 Several studies in mouse models of adenomyosis have supported the efficacy of these treatments for adenomyosis or provided insight into their mechanisms of action.…”

“…Although adenomyosis is asymptomatic in up to one-third of women with the disease, severe, persistent pelvic pain is a commonly reported symptom, and there is a correlation between the spread of adenomyosis throughout the myometrium and pelvic pain. 2,3,94 Adenomyosis-associated pain cannot be studied directly in mouse models; so, general increased sensitivity to pain (hyperalgesia) is often used as a substitute measure, with the response time of mice to gradually increasing temperature indicating changes in central sensitization. Though not ideal substitutes for analyzing adenomyosis-associated pelvic pain, such experiments are reasonable given the possible association between adenomyosis and neuropathic pain or sensory gain.…”

“…59 Notably, this effect increased with age alongside disease progression and is thought to be involved in both the pathogenesis and pain severity of human adenomyosis. 2,59 Though admittedly all these data were gleaned from experiments in one mouse model and only involves generalized pain sensitivity, they still represent a valuable contribution to the limited understanding of adenomyosis-related pain and possible remedial therapies. Future utilization of mouse models of menstruation or alternative methods of disease induction more closely aligned with human reproductive system biology could offer opportunities to study adenomyosis dysmenorrhea and lead to a more clinically relevant understanding of adenomyosis pain.…”