Increased local prolactin synthesis in the myometrium and endometrium as a probable cause of adenomyosis

Olga Malysheva, Maria I. Yarmolinskaya, Maria A. Shalina, Аndrey S. Glotov
In: Journal of obstetrics and women's diseases · 2026 · vol. 75(4) , pp. 36–44 · doi:10.17816/jowd713728 · W7214995950
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This study found significantly increased prolactin mRNA levels in the endometrium and myometrium of patients with adenomyosis compared to controls, supporting local hyperprolactinemia as a key factor in the disease's pathogenesis.

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This study investigated the role of local prolactin synthesis in the pathogenesis of adenomyosis by measuring prolactin gene expression in reproductive tissues. Researchers utilized real-time reverse transcription polymerase chain reaction to analyze endometrial samples from 104 patients with hyperproliferative gynecological diseases, including adenomyosis, uterine fibroids, and endometriosis, as well as a control group, alongside myometrial analysis in a subset of participants. The results demonstrated a significant and systematic increase in prolactin mRNA levels within both the endometrium and myometrium of patients with adenomyosis compared to controls and those with other conditions, where such increases were not consistent. This paper is centrally about adenomyosis — specifically evaluating the hypothesis that local hyperprolactinemia contributes to its development through elevated tissue-specific gene expression.

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Abstract

BACKGROUND: Adenomyosis is a gynecological condition characterized by the abnormal presence of endometrial glands and stroma within the deeper layers of the myometrium. The role of prolactin in the development of adenomyosis was established earlier in experiments that showed that experimentally induced hyperprolactinemia, both local and systemic, can cause adenomyosis in animal models. Prolactin is also known to be synthesized locally in the female reproductive system, namely, in the endometrium and myometrium. AIM: The aim of this study was to evaluate prolactin gene expression levels in the tissues of the female reproductive system (endometrium, myometrium) in patients with adenomyosis compared with the control group and women with other gynecological diseases (endometriosis, uterine fibroids). METHODS: The real-time reverse transcription polymerase chain reaction method was used to evaluate prolactin gene expression in the endometrium of 104 patients with various hyperproliferative gynecological diseases, such as adenomyosis, uterine fibroids, and endometriosis, as well as in patients of the comparison group. Prolactin gene expression in the myometrium of 17 patients (8 women in the comparison group and 9 women with adenomyosis) was also analyzed. RESULTS: We found a significant increase in prolactin mRNA in the endometrium and myometrium of patients with adenomyosis. Some patients with uterine fibroids or endometriosis and women in the comparison group may experience sharp increases in prolactin mRNA, however, these changes are not systematic. CONCLUSION: The data obtained indicate the important role of local hyperprolactinemia in the pathogenesis of adenomyosis.
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Abstract

BACKGROUND: Adenomyosis is a gynecological condition characterized by the abnormal presence of endometrial glands and stroma within the deeper layers of the myometrium. The role of prolactin in the development of adenomyosis was established earlier in experiments that showed that experimentally induced hyperprolactinemia, both local and systemic, can cause adenomyosis in animal models. Prolactin is also known to be synthesized locally in the female reproductive system, namely, in the endometrium and myometrium. AIM: The aim of this study was to evaluate prolactin gene expression levels in the tissues of the female reproductive system (endometrium, myometrium) in patients with adenomyosis compared with the control group and women with other gynecological diseases (endometriosis, uterine fibroids).

Methods

The real-time reverse transcription polymerase chain reaction method was used to evaluate prolactin gene expression in the endometrium of 104 patients with various hyperproliferative gynecological diseases, such as adenomyosis, uterine fibroids, and endometriosis, as well as in patients of the comparison group. Prolactin gene expression in the myometrium of 17 patients (8 women in the comparison group and 9 women with adenomyosis) was also analyzed.

Results

We found a significant increase in prolactin mRNA in the endometrium and myometrium of patients with adenomyosis. Some patients with uterine fibroids or endometriosis and women in the comparison group may experience sharp increases in prolactin mRNA, however, these changes are not systematic.

Conclusion

The data obtained indicate the important role of local hyperprolactinemia in the pathogenesis of adenomyosis.

Keywords

Full Text About the authors Olga V. Malysheva The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0002-8626-5071 SPIN-code: 1740-2691 Cand. Sci. (Biology) Russian Federation, Saint PetersburgMaria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 Cand. Sci. (Biology) Russian Federation, Saint PetersburgMaria A. Shalina The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-5921-3217 SPIN-code: 6673-2660 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgAndrey S. Glotov The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-7465-4504 SPIN-code: 1406-0090 Dr. Sci. (Biology) Russian Federation, Saint PetersburgReferences - Hashimoto A, Iriyama T, Sayama S, et al. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J Matern Fetal Neonatal Med. 2018;31(3):364–369. doi: 10.1080/14767058.2017.1285895 - Habiba M, Benagiano G, Guo SW. An Appraisal of the Tissue Injury and Repair (TIAR) theory on the pathogenesis of endometriosis and adenomyosis. Biomolecules. 2023;13(6):975. doi: 10.3390/biom13060975 EDN: CUMQJT - Greaves P, White IN. Experimental adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):503–10. doi: 10.1016/j.bpobgyn.2006.01.003 - Mori T, Singtripop T, Kawashima S. Animal model of uterine adenomyosis: is prolactin a potent inducer of adenomyosis in mice? Am J Obstet Gynecol. 1991;165(1):232–4. doi: 10.1016/0002-9378(91)90258-s - Wang R, Xu S, Cui Q, et al. 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