Endometriosis: a life cycle approach?
Abstract
To improve the still fragmented understanding of endometriosis, a life cycle approach was adopted that revealed unexpected aspects of the natural history of the disease throughout a woman's life. Three age-related stages of endometriosis are distinguished. In premenarcheal and adolescent endometriosis, 2 types can be distinguished: a classic form that can occur before menarche, and a congenital obstructive form that is caused by uterine anomaly and outflow obstruction. The lesions include superficial peritoneal implants, but adhesions and endometrioma can also occur. It is suggested that premenarcheal and possibly adolescent endometriosis develop by activation of resting stem cells shed at the time of neonatal retrograde uterine bleeding. In the adult, endometriosis can be related to uterine preconditioning by cyclic menstruations acting as a priming mechanism for deep placentation. In adult life, the typical lesions are peritoneal, ovarian, and deep or adenomyotic endometriosis. More recently, endometriosis has been associated with endometrial dysfunction and myometrial junctional zone hyperplasia. These uterine changes can be linked with some major obstetrical syndromes. In postmenopause, endometriosis can develop or be reactivated both in the presence or absence of exogenous estrogens and can spread to a variety of organs and structures causing constrictive lesions.
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There is an increased incidence of endometriosis in association with structural problems/birth defects of the uterus, cervix, or vagina.
“because of the increased incidence of endometriosis in association with such anomalies (55).”
The rare premenarcheal endometriosis that presents the same phenotype with angiogenic peritoneal implants and the formation of OMA as adolescent endometriosis is unexplained by Sampson's hypothesis.
“There are three major observations that support the hypothesis of neonatal menstruation and the risk of early including the rare premenarcheal endometriosis that presents the same phenotype with angiogenic peritoneal implants and the formation of OMA as adolescent endometriosis, is unexplained by Sampson's hypothesis (33,34).”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [33]
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- Authors
- Brosens, I., Puttemans, P., & Benagiano, G.
- Affiliations
- Leuven Institute for Fertility and Embryology (BE)
- Sapienza University of Rome (IT)
- Corresponding author
- Brosens, Ivo
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 209
- Issue
- 4
- Pages
- 307-316
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2008360061
- Semantic Scholar
- 91283888a6477f7b525d50cfe210d9d2df3f9ce9
- Cited by
- 66
- References
- 124
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 5 · 2020: 9 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 5 · 2014: 4 · 2013: 7
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, life cycle, natural history (disease), adolescent endometriosis, uterine anomalies, endometrioma, peritoneal implants, endometrial stem cells, adenomyosis, endometrial dysfunction, postmenopausal endometriosis, estrogen, peritoneal adhesions
- MeSH terms
- Adolescent, Adult, Endometriosis, Female, Humans, Menarche, Peritoneum, Uterus, Postmenopause, Adolescent Development
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