Cited by 359Endometriosis Research and TreatmentUterine Myomas and TreatmentsGynecological conditions and treatments

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Pathology and physiopathology of adenomyosis

Bergeron, Christine, Amant, Frederic, Ferenczy, Alex·2006·Best Practice & Research Clinical Obstetrics & Gynaecology

DOI 10.1016/j.bpobgyn.2006.01.016

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Abstract

Adenomyosis is defined by the presence of endometrial mucosa within the myometrium. This probably occurs by invagination of the basalis endometrium into the myometrium. The process of invagination and intramyometrial spreading may be facilitated by the non-cyclic, anti-apoptotic activity of the basalis associated with relative hyper-oestrogenic states. Most cases of adenomyosis are discovered in multiparous women during the 'transitional' years (40-50 years), and the condition is associated with menorrhagia, dysmenorrhoea, endometrial polyps and leiomyomata uteri. Endometrioid adenocarcinoma is often associated with adenomyosis, is frequently of early stage and low histological grade, is hormone-sensitive, and has an excellent prognosis. Extension of malignant growth into foci of adenomyosis has no adverse effect on prognosis. Definite diagnosis and treatment of adenomyosis are obtained by hysterectomy. Although adenomyotic endometrial glands are hormone-sensitive, exogenous progestogenic agents are ineffective for the treatment of adenomyosis. Anti-oestrogenic danazol and gonadotrophin-releasing hormone (GnRH) analogues induce suppression of adenomyosis, but their use must be of short duration. Surgical extirpation, therefore, is the best therapeutic option.

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Result
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Background
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BackgroundInfluential
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Background
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“Adenomyosis, a frequent chronic gynecological condition defined by the benign ectopic invasion of endometrial tissue—glands and stroma—into the myometrium with hyperplasia of adjacent uterine smooth muscle cells, is often associated with endometriosis.(23,24) Both entities, endometriosis and adenomyosis, share clinica…”
Background
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Background
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“Adenomyosis can cause chronic menorrhagia and is particularly common in parous women in the perimenopause (11).”
Background
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“The location of uterine adenomyosis is commonly intramural and less frequently subserosal [2].”
Background
Adenomyosis is associated with specific proton nuclear magnetic resonance (1H-NMR) serum metabolic profiles
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“Adenomyosis is an ovarian steroid hormone-dependent disease [1].”
Background
Potential Mechanisms of an Antiadenomyosis Chinese Herbal Formula Shaoyao‐Gancao Decoction in Primary Cell Culture Model
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Mesenchymal Tumors of the Uterus
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Background
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“Unfortunately, although surgical treatment is regarded as the definitive therapy for adenomyosis, it can be traumatic for women who are symptomatic but have a strong desire to conceive.(11,12) In addition, evidence has shown several limitations of the medical approaches, including severe premenopausal symptoms, freque…”
Background
Investigation of the role of platelets in the aetiopathogenesis of adenomyosis
Mosele, S., Stratopoulou, C. A., Camboni, A., Donnez, J., & Dolmans, M. (2021) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2021.01.009 · Cited by 16
The Role of Abnormal Uterine Junction Zone in the Occurrence and Development of Adenomyosis
Xie, T., Xu, X., Yang, Y. L., Wu, C., Liu, X., Zhou, L., & Song, Y. (2021) · Reproductive Sciences · doi:10.1007/s43032-021-00684-2 · Cited by 16
Mesenchymal uterine tumors, other than pure smooth muscle neoplasms, and adenomyosis
McCluggage, W. G., & Robboy, S. J. (2009) · Elsevier eBooks · doi:10.1016/b978-0-443-07477-6.50022-6 · Cited by 16
Loss of APC function in mesenchymal cells surrounding the Müllerian duct leads to myometrial defects in adult mice
Wang, Y., Jia, Y., Franken, P., Smits, R., Ewing, P. C., Lydon, J. P., DeMayo, F. J., Burger, C. W., Grootegoed, J. A., Fodde, R., et al. (2011) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2011.05.026 · Cited by 16
“and glandular cells from the endometrium reminiscent for a human disorder described as endometriosis interna or adenomyosis (Bergeron et al., 2006).”
Surgical Management of Abnormal Uterine Bleeding in Fertile Age Women
Finco, A., Centini, G., Lazzeri, L., & Zupi, E. (2015) · Women s Health · doi:10.2217/whe.15.12 · Cited by 15
Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: A systematic review and meta-analysis
Wang, D.-G., Ji, L., Jia, C.-L., & Shao, M. (2023) · Taiwanese Journal of Obstetrics and Gynecology · doi:10.1016/j.tjog.2023.07.004 · Cited by 14
Overview of crosstalk between stromal and epithelial cells in the pathogenesis of adenomyosis and shared features with deep endometriotic nodules
Zipponi, M., Cacciottola, L., & Dolmans, M. (2024) · Human Reproduction · doi:10.1093/humrep/deae116 · Cited by 14
Adenomyosis-associated infertility: an update of the immunological perspective
Cao, Y., Yang, D., Cai, S., Yang, L., Yu, S., Geng, Q., Mo, M., Li, W., Wei, Y., Li, Y., et al. (2024) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2024.104703 · Cited by 20
The Possible Role of Eukaryotic Translation Initiation Factor 3 Subunit e (eIF3e) in the Epithelial—Mesenchymal Transition in Adenomyosis
Cai, X., Shen, M., Liu, X., & Nie, J. (2018) · Reproductive Sciences · doi:10.1177/1933719118773490 · Cited by 14
“Progestogenic agents are not very effective, and the efficacy of gonadotropin-releasing hormone (GnRH) agonists is restricted by their short duration.(2) In addition, symptoms often recur after discontinuation of GnRH agonists therapy,(4) leaving the only perpetual effective treatment as hysterectomy.”
Background
Expression of Nerve Injury-Induced Protein1 (Ninj1) in Endometriosis
Miyashita‐Ishiwata, M., Koga, K., Takeuchi, A., Makabe, T., Taguchi, A., Urata, Y., Izumi, G., Takamura, M., Harada, M., Hirata, T., et al. (2018) · Reproductive Sciences · doi:10.1177/1933719118806395 · Cited by 14
Cystic adenomyosis spreading into subserosal-peduncolated myoma
Calagna, G., Cucinella, G., Tonni, G., Gregorio, R. D., Triolo, O., Martorana, A., Perino, A., & Granese, R. (2015) · International Journal of Surgery Case Reports · doi:10.1016/j.ijscr.2015.01.005 · Cited by 14
Drug Development in Endometriosis and Adenomyosis: It Takes More Than Just Good Science
Groothuis, P. G., & Guo, S.-W. (2018) · Reproductive Sciences · doi:10.1177/1933719118785767 · Cited by 13
Characteristics of histologically confirmed endometriosis in cynomolgus monkeys
Nishimoto-Kakiuchi, A., Netsu, S., Matsuo, S., Hayashi, S., Ito, T., Okabayashi, S., Yasmin, L., Yuzawa, K., Kondoh, O., Kato, A., et al. (2016) · Human Reproduction · doi:10.1093/humrep/dew209 · Cited by 13
“Adenomyosis was diagnosed by histopathological criteria (the presence of endometriotic gland and stromal cells in the inner 90% of the myometrium of the uterine wall) (Bergeron et al., 2006; Sato et al., 2012).”
Uterine artery embolisation in women with symptomatic adenomyosis
Lohle, P. N. M., Higué, D., & Herbreteau, D. (2019) · La Presse Médicale · doi:10.1016/j.lpm.2019.03.013 · Cited by 13
Epigenetic regulation of Progesterone Receptor isoforms: From classical models to the sexual brain
Vázquez-Martínez, E. R., Mendoza‐Garcés, L., Vergara, E., & Cerbón, M. A. (2014) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2014.05.011 · Cited by 12
Comparison of Sensitivity and Specificity of Structured and Narrative Reports of Transvaginal Ultrasonogaphy for Adenomyosis
da Silva, J. R., Andres, M. P., Leite, A. P. K., Gomes, M. T. N. D. A., Neto, J. S., Baracat, E. C., Carmona, F., & Abrão, M. S. (2020) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2020.11.001 · Cited by 12
“The gold standard for the diagnosis of adenomyosis is the histological evaluation of affected tissue samples, whether from hysterectomy, adenomyomectomy, or uterine biopsy [4-7].”
Background
Perinatal outcomes associated with the positional relationship between the placenta and the adenomyosis lesion
Ono, Y., Ota, H., Takimoto, K., Tsuzuki, Y., Nakajima, A., Yoshino, O., Unno, N., Fujino, T., Fukushi, Y., & Wada, S. (2021) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2021.102114 · Cited by 12
Diagnostic accuracy of clinically reported adenomyosis on pelvic ultrasound and MRI compared to surgical pathology
Zanolli, N. C., Cline, B. C., Befera, N. T., & Martin, J. G. (2021) · Clinical Imaging · doi:10.1016/j.clinimag.2021.11.012 · Cited by 12
Effects of Levonorgestrel-Releasing Intrauterine System on Lymphangiogenesis of Adenomyosis
Cho, S., Choi, Y. S., Yun, B. H., Chon, S. J., Jung, Y. S., Kim, H. Y., Park, J. H., Seo, S. K., Kim, S. H., & Lee, B. S. (2015) · American Journal of Clinical Pathology · doi:10.1309/ajcpp8f4sfyfvxrn · Cited by 12
Impact of coexistent adenomyosis on outcomes of patients with endometrioid endometrial cancer: a propensity score-matched analysis
Aydın, H. A., Toptaş, T., Bozkurt, S., Peştereli, E., & Şimşek, T. (2017) · Tumori Journal · doi:10.5301/tj.5000698 · Cited by 12
Intrauterine levonorgestrel delivery with frameless fibrous delivery system: review of clinical experience
Wildemeersch, D. A., Andrade, A. T. L., Goldstuck, N. D., Hasskamp, T., & Jackers, G. (2017) · International Journal of Women s Health · doi:10.2147/ijwh.s122579 · Cited by 12
Depleted-MLH1 Expression Predicts Prognosis and Immunotherapeutic Efficacy in Uterine Corpus Endometrial Cancer: An In Silico Approach
Wolde, T., Huang, J. H., Huang, P., Pandey, V., & Qin, P. (2024) · BioMedInformatics · doi:10.3390/biomedinformatics4010019 · Cited by 11
The matrix stiffness is increased in the eutopic endometrium of adenomyosis patients: a study based on atomic force microscopy and histochemistry
Wang, X., Cai, W., Liang, T., Li, H., Gu, Y., Wei, X., Zhang, H., & Yang, X. (2024) · European Journal of Histochemistry · doi:10.4081/ejh.2024.4131 · Cited by 11
Navigating through perplex morphologic changes after exogenous hormone usage
Chang, R., Rivera-Colón, G., Chen, H., Niu, S., Carrick, K. S., Lucas, E., Gwin, K., & Zheng, W. (2021) · Seminars in Diagnostic Pathology · doi:10.1053/j.semdp.2021.10.001 · Cited by 11
An update on adenomyosis uteri
Hong, S. C., & Khoo, C. K. (2015) · Gynecology and Minimally Invasive Therapy · doi:10.1016/j.gmit.2015.08.003 · Cited by 11
Differences in Mitochondrial Proteins in the Eutopic Endometrium of Patients with Adenomyosis and Endometriosis Identified Using Surface-enhanced Laser Desorption/Ionization Time-of-flight Mass Spectrometry
Ding, X., Wang, L., Ren, Y., & Zheng, W. (2010) · Journal of International Medical Research · doi:10.1177/147323001003800325 · Cited by 11
Coexistence of adenomyosis uteri and endometrial cancer is associated with an improved prognosis compared with endometrial cancer only
Hertlein, L., Rath, J., Zeder-Göß, C., Fürst, S. T., Bayer, D., Trillsch, F., Mahner, S., Burges, A., & Jeschke, U. (2017) · Oncology Letters · doi:10.3892/ol.2017.6592 · Cited by 11
“In hysterectomy specimens obtained during the treatment of EEC, AM may be found in 16-42% (3-6).”
Background
In the mouse, prostaglandin D2 signalling protects the endometrium against adenomyosis
Philibert, P., Déjardin, S., Pirot, N., Pruvost, A., Nguyen, A. L., Bernex, F., Poulat, F., & Boizet‐Bonhoure, B. (2021) · Molecular Human Reproduction · doi:10.1093/molehr/gaab029 · Cited by 11
Bioinformatic analysis and machine learning to identify the diagnostic biomarkers and immune infiltration in adenomyosis
Liu, D., Yin, X., Guan, X., & Li, K. (2023) · Frontiers in Genetics · doi:10.3389/fgene.2022.1082709 · Cited by 11
“The most widely accepted theory for the etiology of adenomyosis is the invagination of the basalis endometrium into the myometrium (Bergeron et al., 2006), which indicates FIGURE 5 Validation of hub genes using qRT-PCR.”
Method
Coexistence of uterine adenomyosis is not associated with a better prognosis in endometrioid-type endometrial cancer
Aslan, K., Sarı, M. E., Yalçın, H. R., Yalçın, İ., Cüylan, Z. F., & Özdal, B. (2020) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-020-02172-z · Cited by 11
Subserous Cystic Adenomyosis: A Case Report and Review of the Literature
Xu, T., Li, Y., Jiang, L., Liu, Q., & Liu, K. (2022) · Frontiers in Surgery · doi:10.3389/fsurg.2022.807676 · Cited by 10
“Adenomyosis is a common gynecological disease in gynecology caused by the infiltration of the myometrium by the glands and stroma of the endometrium (28).”
Background
Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes
Günther, V., Allahqoli, L., Gitas, G., Maass, N., Tesch, K., Ackermann, J., Rosam, P., Mettler, L., von Otte, S., & Alkatout, İ. (2022) · Biomedicines · doi:10.3390/biomedicines10123245 · Cited by 10
“Thus, the disease appears to be estrogen-dependent and can be reactivated post-menopause in cases of preexisting lesions [7].”
Background
Down-regulation of tumor suppressor PDCD4 expression in endometrium of adenomyosis patients
Liu, Y., Tan, X., Wang, Z., Li, Y., Gao, M. Q., Li, Y., Fang, Z., Sun, Y., Zhang, L., Wang, X., et al. (2016) · Current Research in Translational Medicine · doi:10.1016/j.retram.2016.04.008 · Cited by 10
Adjuvant therapy in conservative surgery for adenomyosis
Chao, X., Song, X., Wu, H., You, Y., Li, L., & Lang, J. (2020) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13573 · Cited by 10
Barriers to self‐management of patients with adenomyosis: A qualitative study
Huang, R., Li, X., Jiang, H., & Li, Q. (2021) · Nursing Open · doi:10.1002/nop2.1148 · Cited by 10
“The major clinical manifestations of adenomyosis include menorrhagia, dysmenorrhea, infertility, chronic pelvic pain and enlarged uterine volume (Bergeron et al., 2006; Farquhar & Brosens, 2006).”
Background
From Invaginating Site to Deep Lesion: Spatial Transcriptomics Unravels Ectopic Endometrial Penetration Features in Adenomyosis
Li, B., Qi, J., Cao, Y., Long, Y., Wei, Z., Wang, W., Hu, S., Wang, Y., Zhu, Q., Hu, X. J., et al. (2025) · Advanced Science · doi:10.1002/advs.202411752 · Cited by 10
RNA-seq reveals co-dysregulated circular RNAs in the adenomyosis eutopic endometrium and endometrial–myometrial interface
Guo, Z., Duan, H., Wang, S., Wang, S., Lin, Q., & Li, Y. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01871-2 · Cited by 9
“The diagnosis of adenomyosis was confirmed by histological examination by two pathologists as the presence of ectopic endometrial tissue (endometrial stroma and glands) within the myometrium [30].”
Method

Authors: Bergeron, C., Amant, F., & Ferenczy, A.
Affiliations: Processus d'Activation Sélective par Transfert d'Énergie Uni-électronique ou Radiatif (FR)
Jewish General Hospital (CA)
Corresponding author: Bergeron, Christine
ORCID: Bergeron, Christine
Venue: Best Practice & Research Clinical Obstetrics & Gynaecology
Publisher: Elsevier BV
Published: 2006-08
Volume: 20
Issue: 4
Pages: 511-521
ISSN: 1521-6934 (ISSN-L)
DOI: 10.1016/j.bpobgyn.2006.01.016
OpenAlex: W2038354928
Cited by: 359
References: 54
Citations by year: 2026: 13 · 2025: 16 · 2024: 19 · 2023: 33 · 2022: 25 · 2021: 36 · 2020: 35 · 2019: 26 · 2018: 19 · 2017: 20 · 2016: 19 · 2015: 27 · 2014: 18 · 2013: 10 · 2012: 11
FWCI: 0.59
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Best Practice & Research Clinical Obstetrics & Gynaecology (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Topics: Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
Keywords: adenomyosis, anti-apoptotic effects, hyperoestrogenism, menorrhagia, dysmenorrhea, endometrial polyps, uterine fibroids, endometrioid carcinoma, hysterectomy, danazol, GnRH analogues, progestogens, surgical treatment
MeSH terms: Adult, Danazol, Endometrial Hyperplasia, Endometriosis, Estrogen Antagonists, Female, Humans, Hysterectomy, Leiomyoma, Gonadotropin-Releasing Hormone, Middle Aged, Polyps, Uterine Diseases, Uterine Neoplasms, Endometrial Neoplasms, Carcinoma, Endometrioid

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Pathology and physiopathology of adenomyosis

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