Endometriosis: A dysfunction and disease of the archimetra
Abstract
Endometriosis is considered primarily a disease of the endometrial-subendometrial unit or archimetra. The clinical picture of endometriosis characterises this disease as a hyperactivation of genuine archimetrial functions such as proliferation, inflammatory defence and peristalsis. While the aetiology of the disease remains to be elucidated, a key event appears to consist in the local production of extraovarian oestrogen by a pathological expression of the P450 aromatase. The starting event may consist in a hyperactivity of the endometrial inflammatory defence, a hyperactivity of the endometrial oxytocin/oxytocin receptor system or in the pathological expression of the P450 aromatase system itself. Regardless of which of these levels the starting event is localized in, they influence each other on both the level of the archimetra and the endometriotic lesions. Locally elevated oestrogen levels inevitably up-regulate the endometrial oxytocin mRNA and increased levels of oxytocin result in uterine hyperperistalsis, increased transtubal seeding of endometrial tissue fragments and finally subfertility and infertility by impairment of the uterine mechanism of rapid and sustained sperm transport. Locally increased levels of oestrogen lead, on both the level of the endometrial-subendometrial unit and the endometriotic lesion, to processes of hyperproliferation. These processes result, on the level of the uterus, in an infiltrative growth of elements of the archimetra into the neometra and, on the level of the endometriotic lesion, in infiltrative endometriosis. There is circumstantial evidence that trauma might be an important initial event that induces the specific biochemical and cellular responses of the archimetra. This model is able to explain both the pleiomorphic appearance of endometriosis and the, up until now, enigmatic infertility associated with mild and moderate endometriosis.
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There is one single origin of EM, DIE and AM, namely archimetrosis.
“We postulate and follow the theory of Leyendecker et al. that there is one single origin of EM, DIE and AM, namely archimetrosis [13].”
From Women with Endometriosis—Who Is at Risk for Complications Associated with Pregnancy and Childbirth? A Retrospective Case–Control Study (2024) · cites this paper as [13]
Auto-traumatization of the uterus constitutes the critical factor in the development of endometriosis and adenomyosis.
“On the basis of the data presented above we had suggested that auto-traumatization of the uterus would constitute the critical factor in the development of endometriosis and adenomyosis [3, 4, 33].”
From The pathophysiology of endometriosis and adenomyosis, tissue injury and repair (2009) · cites this paper as [4]
Uterine dysfunction in women with endometriosis and adenomyosis is a result of archimetral hyperestrogenism.
“It was suggested that this uterine dysfunction in women with endometriosis and adenomyosis is a result of archimetral hyperestrogenism [3, 4, 29, 33].”
From The pathophysiology of endometriosis and adenomyosis, tissue injury and repair (2009) · cites this paper as [4]
Intensity of uterine peristaltic activity in women with endometriosis resembles that of women during controlled ovarian hyperstimulation although peripheral estradiol levels are within normal range.
“The intensity of uterine peristaltic activity in women with endometriosis resembles that of women during controlled ovarian hyperstimulation although the peripheral estradiol levels are within the normal range [4, 29, 44].”
From The pathophysiology of endometriosis and adenomyosis, tissue injury and repair (2009) · cites this paper as [4]
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BackgroundInfluentialA new concept of endometriosis and adenomyosis, tissue injury and repair (TIAR)
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Self-citationTaniguchi, F. (2011) · Frontiers in Bioscience · doi:10.2741/e277 · Cited by 141 · see citing works
Risks of adverse pregnancy outcome in endometriosis
Brosens, I., Brosens, J. J., Fusi, L., Al-Sabbagh, M., Kuroda, K., & Benagiano, G. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.02.024 · Cited by 132 · see citing works
Chan, R. W. S., Ng, E. H. Y., & Yeung, W. S. B. (2011) · The American Journal of Pathology · doi:10.1016/j.ajpath.2011.02.025 · Cited by 98 · see citing works
Leyendecker, G., Kunz, G., Kissler, S., & Wildt, L. (2006) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2006.01.008 · Cited by 94 · see citing works
Self-citationEndometriosis and adenomyosis: Similarities and differences
Donnez, J., Stratopoulou, C. A., & Dolmans, M.-M. (2024) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2023.102432 · Cited by 57 · see citing works
Redefining endometriosis: Endometriosis is an entity with extreme pleiomorphism
Leyendecker, G. (2000) · Human Reproduction · doi:10.1093/humrep/15.1.4 · Cited by 49 · see citing works
Self-citationDonnez, O., Van Langendonckt, A., Defrère, S., Colette, S., Van Kerk, O., Dehoux, J.-P., Squifflet, J., & Donnez, J. (2013) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.10.032 · Cited by 42 · see citing works
Naem, A., Krentel, H., Moawad, G., Naem, J., Venezia, R., Etrusco, A., Terzic, S., & Laganà, A. S. (2024) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2024.102500 · Cited by 15 · see citing works
Gruber, T. M., Ortlieb, L., Henrich, W., & Mechsner, S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13020414 · Cited by 9 · see citing works
“We postulate and follow the theory of Leyendecker et al. that there is one single origin of EM, DIE and AM, namely archimetrosis [13].”
Method
- Authors
- Leyendecker, G.
- Affiliations
- Goethe University Frankfurt (DE)
- Corresponding author
- Leyendecker, G
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 1998-09-01
- Volume
- 4
- Issue
- 5
- Pages
- 752-762
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- OpenAlex
- W2142441134
- Cited by
- 199
- References
- 88
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 7 · 2016: 8 · 2015: 14 · 2014: 11 · 2013: 6 · 2012: 10
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction Update (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, aromatase, oxytocin, subfertility, infertility, sperm transport, endometrial trauma
- MeSH terms
- Aromatase, Endometriosis, Endometrium, Estrogens, Female, Gene Expression Regulation, Humans, Infertility, Female, Models, Biological, Oxytocin, RNA, Messenger, Transcription, Genetic, Uterus
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