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Adenomyosis: Mechanisms and Pathogenesis.

Junyu Zhai1,2,3, Silvia Vannuccini4,5, Felice Petraglia4

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Adenomyosis, a uterine disorder causing heavy bleeding and pain, occurs when endometrial cells invade the uterine muscle. Research explores various theories on its development to find better treatments.

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Area of Science:

  • Gynecology
  • Reproductive Medicine
  • Pathology

Background:

  • Adenomyosis is a prevalent uterine condition characterized by endometrial cells within the myometrium.
  • It leads to symptoms such as heavy menstrual bleeding (HMB), pelvic pain, and infertility.
  • The precise pathogenesis and mechanisms of adenomyosis remain incompletely understood.

Purpose of the Study:

  • To review and analyze proposed etiologies for adenomyosis development.
  • To discuss supporting data for various underlying mechanisms of the disease.
  • To explore potential pathways for targeted therapeutic development.

Main Methods:

  • Literature review and synthesis of current theories on adenomyosis pathogenesis.
  • Analysis of proposed mechanisms including endometrial-myometrial interface trauma, stem cell metaplasia, and hormonal influences.
  • Discussion of the relationship between proposed mechanisms and clinical manifestations.

Main Results:

  • Several theories explain adenomyosis, including endometrial invasion, stem cell metaplasia, retrograde menstruation, hormonal induction, and abnormal uterine development.
  • Symptoms like dysmenorrhea, HMB, and infertility are linked to inflammation, neurogenesis, angiogenesis, and contractile dysfunction.
  • Understanding these mechanisms is crucial for developing effective treatments.

Conclusions:

  • Adenomyosis pathogenesis is multifactorial, involving complex interactions at the cellular and molecular levels.
  • Further research into these mechanisms can guide the development of novel, targeted therapies.
  • Current treatments are often palliative, highlighting the need for a deeper understanding of adenomyosis etiology.