ADENOMYOSIS: MODERN ASPECTS OF PATHOGENESIS, DIAGNOSTICS AND TREATMENT

This article presents a review of the literature on risk factors for adenomyosis and internal endometriosis in women. A literature search was conducted in PubMed, Scopus, Web of Science, eLibrary, and Cyberleninka covering the past 10 years. The search was conducted using the following keywords: adenomyosis, internal endometriosis, gynecological pathology, women’s health, and female infertility. Adenomyosis is a global problem in modern obstetrics due to its wide prevalence in different countries and its significant contribution to the frequency of women seeking gynecological care worldwide. Despite significant advances in the management of patients with this pathology, problems with the diagnosis and treatment of these pathological conditions still persist. Therefore, studying the risk factors for adenomyosis is of great importance for identifying women with risk factors and predicting the likelihood of infertility, which will facilitate the timely implementation of preventive measures. Adenomyosis, or internal endometriosis, is a common estrogen-dependent disease characterized by the invasion of the endometrial glands and stroma into the myometrium. The pathology has a chronic relapsing course and is accompanied by severe dysmenorrhea, abnormal uterine bleeding and infertility, which significantly reduces the quality of life of women of reproductive age. This review systematizes and analyzes modern data on the etiology, pathogenesis, methods of non-invasive diagnostics and approaches to the treatment of adenomyosis. Particular attention is paid to the complex interaction of hormonal, inflammatory, immune and epigenetic factors in the development of the disease, its impact on reproductive function, as well as organ-preserving and experimental methods of therapy. Unresolved issues and promising areas for further research to develop personalized patient management tactics are outlined. Keywords: adenomyosis, internal endometriosis, dysmenorrhea, infertility, hormonal therapy, ultrasound, MRI, organ-preserving treatment.