The uterine junctional zone of endoand myometrium: morphofunctional features and importance in obstetric and gynecologic pathogenic mechanism

О. А. Романова, Konstantin S. Churkin, Victoria A. Pechenikova
In: Bulletin of the Russian Military Medical Academy · 2017 · vol. 19(2) , pp. 201–205 · doi:10.17816/brmma623378 · W4388839301
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

The uterine junctional zone, a specialized inner myometrial layer, undergoes cyclic and age-related changes impacting implantation, placentation, and potentially causing obstetric complications like miscarriage and adenomyosis, detectable via imaging.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper is a review synthesizing published evidence on the uterine junctional zone (transformation zone) between endometrium and myometrium, including its embryologic origin, morphofunctional features, and hormone-dependent cyclic changes. It summarizes high-resolution imaging and morphologic work suggesting the junctional zone is a specialized, hormone-dependent inner myometrial layer whose thickness varies with menstrual phase, hormonal contraceptive use, patient age, and potentially reflects uterine involvement by adenomyosis when thickness exceeds 12 mm. The review links junctional zone alterations to implantation and placentation and cites associations with early pregnancy loss and obstetric complications, including findings from an IVF MRI study on implantation disruption. This paper does not explicitly state limitations of the overall evidence base beyond noting that the junctional zone is not accessible to invasive assessment and is typically evaluated via imaging. This paper is centrally about endometriosis — it discusses the transformation/junctional zone as part of the uterine architecture that is influenced by and implicated in uterine pathology including endometriosis.

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Abstract

The integrated data of foreign authors on a structure, an embr yogenesis and functional features of the junctional zone, its value in development of pathology of a uterus and the course of pregnancy are submitted. It is established that a uterus consists of two layers: internal – an archimetra and external – neometra. The junctional zone belongs to the archimetra and represents the highly specialized hormone-dependent structure being is an inner (subvascular) layer of myometrium. Unlike endometrium the transformation zone isn’t available for aggressive approach, its structure and function can be estimated only by means of imaging modalities. The metastructure of myocytes of the junctional zone undergoes characteristic cyclic changes depending on a phase of the menstrual period, intake of hormonal contraceptives and the age of the patient. During the research of the junctional zone in women of different age gradual increase in thickness of this zone in patients aged of 30 years and older was revealed, and of 34 years and older the sharp increase in its thickness was noted. It is also stated that the junctional zone plays an important role in processes of implantation and placentation and together with endometrium represents a placental bed. Abnormality of the junctional zone could be the reason for early term miscarriages, failed attempts of in vitro fertilization and obstetric complications. On the basis of a number of comparative researches it is proved that the transformation zone thickness of more than 12 mm is the criterion of a uterus involvement by adenomyosis. Thus, the measurement of thickness of the junctional zone during the transvaginal ultrasonography and magnetic resonance imaging could be successfully applied to the screening of adenomyosis, and also to predictability of early term miscarriages and development of the pregnancy complications related to derangement of placentation.

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adenomyosis

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