Pathogenesis of adenomyosis

Adenomyosis is a common benign condition, often diagnosed in women of reproductive age with dysmenorrhea and polymenorrhea, miscarriage and infertility. Previously, it was believed that the pathological process was associated with intrauterine interventions, parturition or endometriosis diagnosed by histological examination as the gold standard. Currently, adenomyosis is perceived as an independent disease, the etiology and pathogenesis of which are based on complex molecular, genomic and immune processes, also occurring in women without a burdened maternal obstetric and gynecological history. Modern non-invasive diagnostic methods, such as ultrasonography and magnetic resonance imaging, have high sensitivity and specificity and are successfully used for diagnosis of adenomyosis. One of the main initial morphological and functional signs of the disease is a change in the so-called J-zone (junctional zone, JZ), which is the transitional part of the myometrium. Its subendometrial layer has unique structural organization, immunohistochemical structure and functional activity, which remains not fully understood. Data on the effect of adenomyosis on the course and outcome of pregnancy are mixed. This article presents a literature review of world studies on the etiology, pathogenesis and diagnosis of adenomyosis and its effect on fertility.