Adenomyosis – a female disease similar to endometriosis

What are the symptoms of adenomyosis? How can we improve the diagnostic process and treatment? Researchers form the PAS Institute of Animal Reproduction and Food Research provided answers to these questions.

Until recently, it was believed that if a woman had a problem with heavy menstrual bleeding, fertility or menstrual pain, then „this is her beauty”. Today we know that these may be symptoms of, for example, adenomyosis – a female disease similar to endometriosis. Research results were published in the Journal of Clinical Medicine.

Adenomyosis – a less known form of endometriosis

Adenomyosis is an estrogen-dependent disease similar to endometriosis. – In endometriosis, endometrial tissue, the lining inside the uterus, abnormally migrates to other places in the body, including the intestines or around the anus. With adenomyosis, these tissues get into the uterine muscle – explains the author of the study, Maria Sztachelska, MD, PhD from the Department of Biology and Pathology of Human Reproduction at the PAS Institute of Animal Reproduction and Food Research in Olsztyn.

The main symptoms of adenomyosis are very heavy menstrual bleeding, perimenstrual pain and pain during intercourse, thickening of the uterine walls in the ultrasound image, infertility problems, general malaise, and a tendency to anemia.

The exact mechanism of adenomyosis formation is not yet known. As Maria Sztachelska emphasizes, one of the theories is the presence of excessive contractile activity of the uterus, which leads to micro-trauma and the mucous membrane tissue inside the uterus instead of exfoliating outside (during menstruation) penetrates inside this wall.

(Not) essential estrogen

Adenomyosis is an estrogen-dependent disease, which means that estrogens are the key hormones driving its growth.

– In our studies, we wanted to determine the profile of hormone receptors and we showed the presence of all nuclear and membrane estrogen and progesterone receptors. We suspect that in the case of adenomyosis – as in endometriosis – the mechanism of disease formation is most likely related to the expression of the beta estrogen receptor, which is not present in the normal endometrium – the researcher points out.

Studies have also shown that adenomyosis is able to drive its own development, because its tissues themselves produce estradiol (biologically active estrogen), and this promotes cell proliferation. – In addition, adenomyosis also produces prolactin, which inhibits apoptosis, i.e. the process of cell destruction. All this increases the lifespan of adenomyosis and therefore its complete recovery is still a challenge – emphasizes Maria Sztachelska.

Better diagnosis and targeted therapy

Currently, adenomyosis can be treated in two ways. The first path is radical, surgical treatment.

– The second option, often used after the surgery, is pharmacological treatment. Currently, the therapy most often consists in the use of GnRH antagonists, which inhibit the production of estradiol. However, they cannot be used indefinitely, because estradiol is necessary for a woman – it affects e.g. skin, hair, nails, well-being. Our previous research, led by Dr. Donata Ponikwicka-Tyszko, on the biology of endometriosis, indicates that GnRH antagonist therapy in combination with estradiol can be used over a long period of time and has good effects. Currently, the potential of targeted therapy, e.g. in the form of antibodies directed at specific receptors, is also being investigated, emphasizes Maria Sztachelska.

The test results may also contribute to better diagnosis. – Since we showed a high expression of the estrogen receptor beta, knowing this altered profile of receptors, it would be possible to determine whether a woman is potentially at risk of adenomyosis by examining the endometrial tissue taken in a biopsy, even before the onset of the symptoms – the researcher points out.

– Until recently, it was believed that if a woman has a problem with heavy menstrual bleeding, fertility or menstrual pain, then „this is her beauty”. Fortunately, today the awareness and detection of endometriosis or adenomyosis is increasing. And this is not a marginal problem, because these diseases can affect up to every fifth woman – sums up Maria Sztachelska.

Source of information: PAS Institute of Animal Reproduction and Food Research