Adenomyosis

L. Kiesel, K.-W. Schweppe

This issue of Journal of Reproductive Medicine and Endocrinology focuses on clinical and scientific findings on adenomyosis based on lectures presented at a symposium of the Endometriosis Research Foundation (SEF) during the World Congress of Endometriosis in Vancouver in May 2017.

Adenomyosis is commonly associated with severe dysmenorrhea, pelvic pain and dysfunctional uterine bleeding as well with infertility. It is defined as the presence of endometrial cells in the myometrium. Its prevalence has been shown to be around 30 % of hysterectomy specimen and may increase even up to 80–90% in women with endometriosis.

Until now, the origin and pathophysiology of this disease has remained enigmatic but preclinical and clinical data suggest several mechanisms which may be involved. In this issue, Mechsner reviews new concepts on the pathogenesis of adenomyosis. In essence, tissue injury at the endometrial junctional zone allows for the translocation of endometrium in some women. These adenomyotic lesions are accompanied by various biochemical and morphological changes of the myometrium which relate to clinical symptoms.

Several microRNA- (miRNA-) dysregulations have been shown to be involved in adenomyosis, as presented in the review of Rohloff et al. miRNAs are short and stable RNA molecules and could be promising biomarkers and therapeutic targets in this disease. According to recent data miR-10b seems to be one of the potential targets. Dysregulation of various genes and miRNAs have been found, but detailed studies are still needed to decode the pathways.

The clinical diagnosis is often uncertain but advanced imaging techniques have increasingly become a reliable support in the preoperative work-up as reviewed in this issue by Krentel. Skills in transvaginal ultrasound as well as the use of MRI can help increasing the accuracy of the diagnosis. Different surgical and medical approaches are summarized in this paper regarding the treatment of patients with this complex disease.

Finally, Bühler and coauthors discuss the relevant findings on the role of adenomyosis in female infertility. The main remaining questions relate to the clinical problem of how to determine the possible impact of adenomyosis on fecundity as well as whether to treat the disease prior to assisted reproductive therapy.

Prof. Dr. Ludwig Kiesel, Universitätsklinikum Münster

Prof. Dr. Karl-Werner Schweppe, Frauenklinik Ammerland