The state of hormonal balance in women with adenomyosis according to the phases of the menstrual cycle and its dependence on the stage of the disease

Halyna Semenyna, Iryna Mandziy, Alla I. Popovych, О.О. Коrytko, M.V. Doroshenko-Kravchyk, О. І. Попович
In: INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine) · 2025 · vol. 21(5) , pp. 537–543 · doi:10.22141/2224-0721.21.5.2025.1604 · W4414261813
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Adenomyosis is associated with altered pituitary-ovarian axis hormones, increased estrogens, decreased progesterone and androgens, elevated leptin, and higher stress hormones correlating with disease stage and pain.

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Abstract

Background. Adenomyosis is a type of genital endometriosis in which heterotopias of endometrioid tissue are found in the myometrium that is accompanied by significant disorders of reproductive and menstrual functions, persistent pain syndrome, dysfunction of adjacent organs, deterioration of the general condition of patients, and decreased work capacity. An undeniable participant in the pathological process in the adenomyosis origin are changes in the neuroendocrine link of the reproductive system whose characteristics and depth of manifestation remain unclear. Aim: to conduct a study of the state of hormonal balance in women with adenomyosis in the follicular and luteal phases of the menstrual cycle and to determine its relationship with the stage and clinical manifestations of the disease. Materials and methods. Ninety-seven women of reproductive age were under observation: 67 were diagnosed with adenomyosis (main group) and 30 were healthy women (control group). The stage of adenomyosis was assessed according to the criteria described by M. Squatrito et al. Hormonal studies included determination of follicle-stimula­ting hormone, luteinizing hormone, sex hormone-binding globulin, progesterone, estradiol, prolactin, cortisol, testosterone, androstenedione, dehydroepiandrosterone, anti-Müllerian hormone, leptin in the follicular and luteal phases of the menstrual cycle. To monitor the quality of life of patients, pain was assessed using a visual analog scale. Statistical processing of the obtained data was carried out using the standard StatSoft Statistica for Windows 13.0 software package. Results. In the follicular phase of the menstrual cycle, all hormones of the pituitary-ovarian axis underwent changes whose depth correlated with the severity of the disease (p < 0.05). The content of estrogens is constantly increasing in the blood serum of women with adenomyosis compared to the control group (p < 0.0001), with especially noticeable increase not only in the content of estradiol, which is physiological under these conditions, but also estrone. A decrease in progesterone and androgen levels was found, which deepened with increasing stage of the disease. The content of stress hormones was highest in the se­cond phase of the menstrual cycle and correlated with pain syndrome (r = 0.91; p < 0.01). The study revealed an increase in leptin levels in women of the main group compared to the control one, which begins with stage II (p < 0.0001), progressively increases with the severity of adenomyosis, exceeding the reference norms by more than 3 times in stage III of the disease (p < 0.0001) that indicates the involvement of metabolic processes in the pathogenesis. Conclusions. The role of changes in metabolism and sex hormones, neuroendocrine disorders of the hypothalamic-pituitary-ovarian axis in the pathogenesis of adenomyosis is undoubted. The most pronounced are changes in the estrogen-gestagen system whose severity correlates with the stage of the disease. All patients with stage III adenomyosis have an increase in the content of stress hormones, which correlates with the severity of the pain syndrome (r = –0.82; p < 0.05). Testosterone levels in adenomyosis are reduced and correlate with cortisol levels (r = –0.67; p < 0.05). The detected increase in leptin levels in women with adenomyosis compared to healthy women (p < 0.0001) occurs with an increase in disease severity and allows us to consider adenomyosis as a multisystem disease.

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endometriosisadenomyosis

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