A new concept of endometriosis and adenomyosis, tissue injury and repair (TIAR)
Abstract
Pelvic endometriosis, deeply infiltrating endometriosis and uterine adenomyosis share a common pathophysiology and may be integrated into the physiological mechanism and new nosological concept of ‘tissue injury and repair’ (TIAR) and may, in this context, just represent the extreme of a basically physiological, estrogen-related mechanism that is pathologically exaggerated in an extremely estrogen-sensitive reproductive organ. The acronym TIAR describes a fundamental and apparently ubiquitous biological system that becomes operative in mesenchymal tissues following tissue injury and, upon activation, results in the local production of estradiol. Endometriosis and adenomyosis are caused by trauma. In the spontaneously developing disease, chronic uterine peristaltic activity or phases of hyperperistalsis induce, at the endometrial-myometrial interface near the fundo-cornual raphe, microtraumatisations, with activation of the TIAR mechanism. With ongoing traumatisations, such sites of inflammation might accumulate and the increasingly produced estrogens interfere in a paracrine fashion with ovarian control over uterine peristaltic activity, resulting in permanent hyperperistalsis and a self-perpetuation of the disease process. Overt autotraumatisation of the uterus with dislocation of fragments of basal endometrium into the peritoneal cavity and infiltration of basal endometrium into the depth of the myometrial wall ensues. In most cases of endometriosis/adenomyosis a causal event early in the reproductive period of life must be postulated, rapidly leading to archimetral hyperestrogenism and uterine hyperperistalsis. In late premenopausal adenomyosis such an event might not have occurred. However, as indicated by the high prevalence of the disease, it appears to be unavoidable that, with time, chronic normoperistalsis throughout the reproductive period of life accumulates to the same extent of microtraumatisation. With activation of the TIAR mechanism followed by chronic inflammation and infiltrative growth, endometriosis/adenomyosis of the younger woman and premenopausal adenomyosis share in principal the same pathophysiology.
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Even within the TIAR framework, the pathogenesis of adenomyosis differs from that of endometriosis.
“Regardless, even within the TIAR framework it seems evident that the pathogenesis of adenomyosis differs from that of endometriosis [28,29,30].”
From The Pathogenesis of Adenomyosis vis-à-vis Endometriosis (2020) · cites this paper as [29]
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Pathogenesis of uterine adenomyosis, invagination or metaplasia?
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“In this context, TIAR represents an estrogen-related mechanism that is pathologically magnified in a reproductive organ that is already estrogen-sensitive [32].”
BackgroundGonadotropin-releasing hormone antagonist (linzagolix): A new therapy for uterine adenomyosis
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Endometriosis and adenomyosis: Similarities and differences
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- Authors
- Leyendecker, G., & Wildt, L.
- Affiliations
- Kinderwunschzentrum (Fertility Center) Darmstadt, Darmstadt, Germany
- Innsbruck Medical University (AT)
- Corresponding author
- Leyendecker, Gerhard
- ORCID
- Wildt, Ludwig
- Venue
- hmbci
- Publisher
- Walter de Gruyter GmbH
- Published
- 2011-03-01
- Volume
- 5
- Issue
- 2
- Pages
- 125-142
- ISSN
- 1868-1883 (ISSN-L)
- 1868-1891
- OpenAlex
- W2035745290
- Semantic Scholar
- c925439c1168a05421c31b0b8d353ac4f342bb15
- Cited by
- 147
- References
- 124
- Citations by year
- 2026: 15 · 2025: 7 · 2024: 14 · 2023: 17 · 2022: 23 · 2021: 19 · 2020: 22 · 2019: 4 · 2018: 11 · 2017: 4 · 2016: 5 · 2015: 3 · 2014: 2
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hormone Molecular Biology and Clinical Investigation (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 › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- endometriosis, adenomyosis, deep infiltrating endometriosis, tissue injury and repair, uterine peristalsis, estrogen, estradiol production, chronic inflammation, paracrine signaling, pathophysiology, disease classification
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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