[Matrix metalloproteinases and their role in menstruation and endometriosis]

Endometriosis is one of the most common benign proliferative disorders of the female genital tract and occurs in up to 20 % of women, leading to symptoms such as chronic pelvic pain, dyspareunia, dysmenorrhea but also sterility. Although retrograde menstruation represents a plausible explanation for the development of endometriosis, several additional factors have to contribute to the establishment, invasion and growth of endometriotic lesions since endometrial cells spilled into the peritoneal cavity can also be detected in the majority of women without evidence of disease. Within this, the ability of endometrial tissue to implant and invade the peritoneal surfaces and underlying tissues appears to be a pathogenic key mechanism for the growth of endometrium outside the uterine cavity. Matrix metalloproteinases (MMPs) constitute a group of enzymes that not only mediate physiologic tissue turnover such as endometrial breakdown at menstruation, but also have been shown to play important roles in the development of invasive and destructive diseases. The altered regulation of endometrial MMPs has therefore also been associated with the pathogenesis of endometriosis, linking the invasive potential of refluxed endometrium to the adhaesion and growth of endometriotic cells. The aim of present work is to review the role of MMPs in processes of menstruation and development of endometriosis.