{"paper_id":"4d5bf648-46fc-462d-980e-c8bbc831188a","body_text":"Dysmenorrhea and uterine innervation in adenomyosis and\nendometriosis\nCitation for published version (APA):\nRees, C., van Vliet, H. A. A. M., & Schoot, B. C. (2023). Dysmenorrhea and uterine innervation in adenomyosis\nand endometriosis: the role of the sacrouterine ligament: reply. American Journal of Obstetrics and Gynecology,\n229(1), 83-84. https://doi.org/10.1016/j.ajog.2023.02.006\nDocument license:\nTAVERNE\nDOI:\n10.1016/j.ajog.2023.02.006\nDocument status and date:\nPublished: 01/07/2023\nDocument Version:\nPublisher’s PDF, also known as Version of Record (includes final page, issue and volume numbers)\nPlease check the document version of this publication:\n• A submitted manuscript is the version of the article upon submission and before peer-review. There can be\nimportant differences between the submitted version and the official published version of record. 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Jul. 2026\n\naberrant reinnervation within the uterosacral insertions\nrather than the adenomyosis itself, as unilateral uterosacral\ninjuries corresponded to ipsilateral pain presentations.\nDo the authors recognize these 2 different patterns of ade-\nnomyosis in their large European series? Do the consequences\nof injuries to uterine nerves account for adverse pregnancy\noutcomes in painful, asymmetrical adenomyosis?\n4 -\nM. J. Quinn, MD, LLM\nDepartment of Pathology\nInternational Peace Maternity and Child Health Hospital\nShanghai Jiao T ong University\n910 Hengshan Rd.\nXujiahui, Shanghai, China\nmjquinn001@icloud.com\nThe author reports no con flict of interest.\nAll studies reported in this letter had appropriate institutional review board\napproval.\nREFERENCES\n1. Rees CO, van Vliet H, Siebers A, et al. The ADENO study: ADeno-\nmyosis and its Effect on Neonatal and Obstetric outcomes: a retro-\nspective population-based study. Am J Obstet Gynecol 2023;229:\n49.e1-12.\n2. Quinn M. Uterine innervation in adenomyosis. J Obstet Gynaecol\n2007;27:287–91.\n3. Quinn M. The endometrial-myometrial interface. Am J Obstet Gynecol\n2003;188:857–8.\n4. Wu XQ, Cai YY, Xia WT, Quinn MJ. The aetiology of pre-eclampsia,\n1945-1953. BJOG 2016;123:2130 .\nª 2023 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.ajog.\n2023.02.005\nDysmenorrhea and uterine innervation in\nadenomyosis and endometriosis: the role of the\nsacrouterine ligament: reply\nWe thank Quinn et al for sharing their findings with us, as\nit is an interesting theory concerning how uterine innerva-\ntion and adenomyosis (symptoms) may be connected. It\nremains a clinical challenge to separate the effects of\nendometriosis and adenomyosis from each other, especially\nconcerning which of the 2 conditions plays the primary role\nin dysmenorrhea. In our study, we were unable to differ-\nentiate the groups based on purely uterine characteristics\nbecause of the limitation of our anonymized datasets, and\nthus, we cannot provide a clear answer to your question.\nFurthermore, we do not have data regarding the state of the\nsacrouterine ligaments in these patients as these are not\nlooked at in all cases.\nHowever, we believe that the presence of adenomyosis itself\nwill still primarily affect uterine innervation and contractility\nbecause of the disruption of myometrial tissue and thereby\ngap junctions and interstitial Cajal-like cells, leading to\nsymptoms. This theory regarding the effect of adenomyosis\non uterine peristalsis has been described in detail in the\nliterature in past years.\n1,2\nIf the sacrouterine ligaments are additionally affected,\nthis may potentially result in further disruption of uterine\ninnervation, and we know that sacrouterine ligament invol-\nvement is associated with more severe dysmenorrhea in\nendometriosis.\n3 This would be an interesting area to inves-\ntigate in prospective studies in the future. However, the\nquestion remains whether added pathology comes from the\ninvasion of the sacrouterine ligament or whether the con-\ncomitant endometriosis is the added severe disease. Our\ngroup is currently in the process of conducting a subanalysis\nusing our existing dataset investigating pregnancy outcomes\nin women with adenomyosis and concomitant endometriosis\nvs adenomyosis alone. Potentially, we will be able to answer\nthis query in more detail.\n-\nConnie Odette Rees, MD, MSc\nDepartment of Gynaecology and Obstetrics\nCatharina Hospital\nEindhoven, The Netherlands\nDepartment of Electrical Engineering\nEindhoven University of T echnology\nEindhoven, The Netherlands\nDepartment of Reproductive Medicine\nGhent University Hospital\nGhent, Belgium\nconnieodetterees@gmail.com\nHubertus A. A. M. van Vliet, MD, PhD\nDepartment of Gynaecology and Obstetrics\nCatharina Hospital\nEindhoven, The Netherlands\nDepartment of Reproductive Medicine\nGhent University Hospital\nGhent, Belgium\nJULY 2023 American Journal of Obstetrics & Gynecology 83\najog.org Letters to the Editors\n\nBenedictus Christiaan Schoot, MD, PhD\nDepartment of Gynaecology and Obstetrics\nCatharina Hospital\nEindhoven, The Netherlands\nDepartment of Electrical Engineering\nEindhoven University of T echnology\nEindhoven, The Netherlands\nDepartment of Reproductive Medicine\nGhent University Hospital\nGhent, Belgium\nThe authors report no con flict of interest.\nThis study was supported by the Catharina Hospital Research Fund.\nREFERENCES\n1. Leyendecker G, Kunz G, Wildt L, Beil D, Deininger H. Uterine hyper-\nperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid\nsperm transport in patients with endometriosis and infertility. Hum\nReprod 1996;11:1542 –51.\n2. Shaked S, Jaffa AJ, Grisaru D, Elad D. Uterine peristalsis-induced\nstresses within the uterine wall may sprout adenomyosis. Biomech\nModel Mechanobiol 2015;14:437 –44.\n3. Gruber TM, Mechsner S. Pathogenesis of endometriosis: the origin of\npain and subfertility. Cells 2021;10:1381 .\nª 2023 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.ajog.\n2023.02.006\nExtending use of levonorgestrel 52 mg intrauterine\ndevice to 8 years\nTO THE EDITORS: We appreciate the journal publishing\nour reports on the extension of the levonorgestrel 52 mg\nintrauterine device (IUD) to 8 years for Liletta\n1 and Mirena,2\nand also for the corresponding editorial. 3 Unfortunately, the\neditorial misrepresents the success rates as reported with life-\ntable analyses. This error is important should a reader choose\nto simply read the editorial as a synopsis and not review the\nstudies themselves.\nThe editorial reports 8-year cumulative pregnancy rates of\n1.09 (95% con fidence interval [CI], 0.56 e2.13) for Liletta\nand 0.68 (95% CI, 0.17 /C02.71) for Mirena.\n1,2 This statement\nimplies that Mirena potentially has a lower pregnancy rate\nthan Liletta. In fact, the life-table pregnancy rate for Liletta\nreflects an 8-year cumulative rate, whereas the rate for Mirena\nonly re flects the 3-year cumulative failure rate using the\nKaplan-Meier method for years 6 to 8. The Liletta study\ndemonstrates a life-table pregnancy rate of approximately\n0.46 in years 6 to 8.\n1\nBecause the Mirena study 2 did not evaluate a single cohort\nfor 8 continuous years, only the data from the Liletta study1 can\nbe used to report the full 8-year cumulative pregnancy risk\nwith levonorgestrel 52 mg IUD use. However, the consistent\nresults between the 2 studies for years 6 to 8 demonstrate that\npatients using either device should experience equivalent\nclinical performance through 8 years of use.\n-\nMitchell D. Creinin, MD\nDepartment of Obstetrics and Gynecology\nUniversity of California, Davis\n4860 Y St, Ste 2500\nSacramento, CA 95817\nmdcreinin@ucdavis.edu\nJeffrey T. Jensen, MD, MPH\nOregon Health & Science University\nPortland, OR\nM.D.C. has received speaking honorarium from Gedeon Richter, Mayne,\nand Organon, serves on an Advisory Board for Gedeon Richter,\nGlaxoSmithKline, OLIC, and Organon, and is a consultant for Estetra\nSRL, Mayne, and Medicines360. The Department of Obstetrics and\nGynecology, University of California, Davis, receives contraceptive\nresearch funding for M.D.C. from Chemo Research SL, Evofem,\nMedicines360, Merck, and Sebela.\nJ.T.J. has received payments for consulting from Bayer Healthcare,\nEvofem, Hope Medicine, Foundation Consumer Healthcare, Mayne\nPharma, ViiV Healthcare, and TherapeuticsMD OHSU has received\nresearch support from Abbvie, Bayer Healthcare, Daré, Estetra\nSPRL, Hope Medicine, Medicines360, Merck, Myovant, and Sebela.\nThese companies and organizations may have a commercial or\nfinancial interest in the results of this research and technology.\nThese potential con flict of interests have been reviewed and\nmanaged by OHSU.\nREFERENCES\n1. Creinin MD, Schreiber CA, Turok DK, Cwiak C, Chen BA, Olariu AI.\nLevonorgestrel 52 mg intrauterine system ef ficacy and safety through 8\nyears of use. Am J Obstet Gynecol 2022;227:871.e1 –7.\n2. Jensen JT, Lukkari-Lax E, Schulze A, Wahdan Y, Serrani M, Kroll R.\nContraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine\nsystem for up to 8 years: findings from the Mirena Extension Trial. Am J\nObstet Gynecol 2022;227:873.e1 –12.\n3. Goldberg AB. Extending use of 52-mg levonorgestrel intrauterine\nsystems to 8 years: bridging phases of life. Am J Obstet Gynecol\n2022;227:803–4.\nª 2023 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.ajog.\n2023.03.011\n84 American Journal of Obstetrics & Gynecology JULY 2023\nLetters to the Editors ajog.org","source_license":"CC0","license_restricted":false}