Origines, caractéristiques, symptômes
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Adenomyosis is the invasion of endometrium (the inner lining of the uterus) into the uterine smooth muscle wall, whose scientific term is "myometrium". In this regard, it differs from endometriosis: adenomyosis lesions show continuity with the endometrium. Adenomyosis can vary greatly in the size and distribution of lesions. Focal adenomyosis may be referred to as myoma, from the Greek "myo" for "muscle" and "ma" for "disease". As yet, no widely agreed classification for adenomyosis has been established (Habiba, Gordts, Bazot et al, Exploring the challenges for a new classification of adenomyosis. RBMO, Volume 40, Issue 4, 2020.).
The prevalence of adenomyosis currently has few studies; the condition is estimated to affect 20% to 65% of people assigned female at birth. (Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd. 2013;73(9):924-931.)
Origins and Traits
For both endometriosis and adenomyosis, cells of origin are theorized as being disseminated via several potential means: growth by expansion and/or infiltration, embryonic rests in Müllerian areas (vagina and Fallopian tubes, uterus for adenomyosis) and non-Müllerian areas (pelvic area, bowel, lungs, and others). Retrograde menstruation is only one additional potential avenue of dissemination (Wang Y, Nicholes K, Shih IM. The Origin and Pathogenesis of Endometriosis. Annu Rev Pathol. 2020;15:71-95.)
Adenomyosis reacts to various stimuli, although the extent of reactions differs between patients. Identified stimuli include inflammation, infection (viral and/or bacterial), estrogen, progesterone, and physical trauma (birth, curettage, surgery).
While pelvic pain is the most recognized symptom for adenomyosis, it is not always present with the conditions. When pain is present, it does not always correlate to severity; pain may also be related to other medical issues. With adenomyosis, pain is generally associated with menses: uterine cramps notably. Depending on the extent and severity, adenomyosis may contribute to infertility or difficulties with fertility.
Diagnosis and treatments
Literature summary by Anna M. Stevenson
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