Nonsurgical management of adenomyosis: an overview of current evidence

Lazaridis, Alexandros; Grammatis, Alexandros; Spencer, Stuart; Hirsch, Martin S.

doi:10.1097/gco.0000000000000810

Cited by 4 publications

(2 citation statements)

References 64 publications

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“…However, despite its common occurrence, it is underdiagnosed and undertreated. It has been reported that the disease is diagnosed on average 10 years after the onset of symptoms, and nonspeci c complaints may lead to consultations regarding various medical management [15]. Considering the signi cant effects of dysmenorrhea and other types of pain regarding women's reproductive health, further investigation is needed.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of TRPM3 by primidone provides a potential therapeutic method for adenomyosis management

Jin

Peng

et al. 2023

Preprint

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Purpose To test the expression profile of transient receptor potential channels (TRPs) in adenomyosis patients and evaluate the effects of primidone on tamoxifen-induced adenomyosis mice. Methods Eutopic endometrium from adenomyosis patients (n = 20) was collected and subjected to mRNA analysis of TRP channels. TRPA1, TRPV1 and TRPM3 in adenomyosis patients (n = 50) and tamoxifen-induced adenomyosis mice (n = 6) were examined by immunohistochemistry. From 10 weeks after birth, primidone (2 mg/kg/d) and atosiban (1 mg/kg/d) were given separately to adenomyotic mice by intraperitoneal injection for 3 weeks. The hotplate test was conducted once a week beginning at 10 weeks, and then uterine samples were harvested for HE staining and RNA-seq at 13 weeks. Results The mRNA expression of 15 TRPs was significantly increased in the proliferative phase of the adenomyotic endometrium. TRPV1, TRPM3 or TRPA1 staining levels were positively correlated with dysmenorrhea severity, menses amount and uterine size. In tamoxifen-induced adenomyosis mice, primidone had a significant effect on both the depth of myometrial infiltration and analgesia. Forty-seven DEGs were identified after primidone treatment, and bioinformatics analysis predicted that they were enriched in the cell cycle and cell division. Conclusion The expression profile of TRP channels varies significantly in adenomyosis patients, and primidone may provide a potential therapeutic method for adenomyosis management.

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Section: Discussionmentioning

confidence: 99%

Inhibition of TRPM3 by primidone provides a potential therapeutic method for adenomyosis management

Jin

Peng

et al. 2023

Preprint

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“…However, it shares some characteristics with malignant tumors, such as an invasive growth of the endometrium into the myometrium. Multiple pathogenic factors influence the development of AM, and its progression is closely related to the complex microenvironment in the endometrial-myometrial interface ( Lazaridis et al, 2022 ). Although there have been numerous attempts to explore the underlying mechanisms and develop drugs that target immune abnormalities, endocrine disorders, and oxidative stress, clinical challenges associated with AM remain unresolved ( Moldassarina, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Role of Pink1-mediated mitophagy in adenomyosis

Chen,

Wang,

et al. 2023

PeerJ

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Background Recent studies indicate that endometrial hypoxia plays a critical role in adenomyosis (AM) development. Mitochondria are extremely sensitive to hypoxic damage, which can result in both morphological and functional impairment. Mitophagy is a crucial mechanism for preserving mitochondrial quality by selectively removing damaged mitochondria, thus ensuring the proper functioning of the entire mitochondrial network. In response to hypoxia, PINK1 is activated as a regulator of mitophagy, but its role in AM requires further study. Objective To explore the potential mechanism of mitophagy mediated by PINK1 in the pathogenesis of AM. Method The study compared PINK1, Parkin, OPTIN, P62, and NDP52 protein expression levels in patients with or without AM using clinical specimens and an AM mouse model. Pathological changes were compared using HE staining. Immunofluorescence and western blot were used to detect protein expression levels. Endometrial stromal cells (ESC) were isolated and examined for mitophagy, protein expression level, and cell invasion ability. Results Both the endometrial tissue from patients with AM and AM ESC displayed an upregulation of protein levels for PINK1, Parkin, OPTIN, P62, and NDP52 when compared with the control group. Then, HE staining confirmed the successful establishment of the AM mouse model. Moreover, the ultrastructural analysis using transmission electron microscopy revealed that AM mice’s endometrial glandular epithelial and stromal cells had exhibited swollen, deformed, and reduced mitochondria along with an increase in the number of lysosomes and mitochondrial autophagosomes. The protein levels of PINK1, Parkin, OPTIN, P62, and NDP52 in uterine tissue from AM mice were noticeably increased, accompanied by a considerable upregulation of ROS levels compared to the control group. In addition, cells in the AM group showed remarkably elevated mitophagy and invasion potentials compared to the control group. In contrast, the cell invasion ability decreased following PINK1 knockdown using the RNA interference technique. Conclusion The high levels of PINK1-mediated mitophagy have been found in AM. The upregulation in mitophagy contributes to mitochondrial damage, which may result in the abnormal invasion characteristic of AM.

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Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

Zeccola,

Allen

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes. Recent findings Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy. Summary This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility.

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Nonsurgical management of adenomyosis: an overview of current evidence

Cited by 4 publications

References 64 publications

Inhibition of TRPM3 by primidone provides a potential therapeutic method for adenomyosis management

Inhibition of TRPM3 by primidone provides a potential therapeutic method for adenomyosis management

Role of Pink1-mediated mitophagy in adenomyosis

Alternative treatments of adenomyosis – an update in procedural management and clinical outcomes

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