Endometriose und Adenomyose

Subscribe to RSS DOI: 10.1055/s-2005-836885 © Georg Thieme Verlag Stuttgart · New York Endometriose und Adenomyose Neue Sichtweisen der Uterus(patho)physiologie Endometriosis and adenomyosisNew insight into uterine (patho)physiologyPublication History Publication Date: 29 September 2005 (online) Zusammenfassung Die uterine Peristaltik ist von fundamentaler Bedeutung im frühen Prozess der Reproduktion. Gleichzeitig ist sie mit der Entwicklung des Krankheitsbildes von Endometriose/Adenomyose kausal verbunden. Eine Endometriose ist mit einer Hyperperistaltik assoziiert. Sie führt zur Desquamation von Fragmenten basalen Endometriums, die vermehrt durch retrograde Menstruation in die Peritonealhöhle gelangen, wo sie Endometrioseherde bilden. Gleichzeitig fördert die Hyperperistaltik die Bildung von myometrialen Dehiszenzen, in die basales Endometrium infiltriert und eine Adenomyose bildet. Die Prävalenz der Adenomyose bei Endometriose beträgt bis zu 90 %. Die Adenomyose ist wesentlich an der Endometriose-assoziierten Sterilität kausal beteiligt. Es liegen Hinweise dafür vor, dass ursächlich für die Hyperperistalsis, also für die Pathogenes von Endometriose und Adenomyose, ein archimetraler Hyperestrogenismus verantwortlich ist, der mit der ovariellen Steuerung der peristaltischen Aktivität interferiert. Die Minimalendrometriose der fertilen Frau, Endometriose und Adenomyose der Sterilitätspatientin sowie die perimenopausale Adenomyose werden als ein pathophysiologisches Kontinuum mit einer prinzipiell gemeinsamen Pathogenese betrachtet. Abstract Peristaltic activity of the non-pregnant uterus serves fundamental functions in the early process of reproduction. Hyperperistalsis of the uterus is significantly associated with the development of endometriosis and adenomyosis. In women with hyperperistalsis fragments of basal endometrium are detached during menstruation and transported into the peritoneal cavity. Fragments of basal endometrium have an increased potential of implantation and proliferation resulting in pelvic endometriosis. In addition, hyperperistalsis induces the proliferation of basal endometrium into myometrial dehiscencies. This results in endometriosis-associated adenomyosis with a prevalence of about 90 %. Adenomyosis results in impaired directed sperm transport and thus constitutes an important cause of sterility in women with endometriosis. The principal mechanism of endometriosis/adenomyosis is the paracrine interference of endometrial estrogen with the cyclical endocrine control of archimyometrial peristalsis exerted by the ovary thus resulting in hyperperistalsis. Minimal endometriosis of the fertile women, endometriosis and adenomyosis of the infertile women and adenomyosis of the parous peri- and postmenopausal women are considered as phenotypes of a pathophysiological continuum with uterine peristalsis playing a prominent role. Schlüsselwörter Endometriose - Adenomyose - Hyperperistaltik - archimetraler Hyperestrogenismus - Sterilität Key words adenomyosis - endometriosis - uterine peristalsis and hyperperistalsis - archimetral hyperestrogenism - infertiliy Literatur - 1 Absenger Y, Hess-Stumpp H, Kreft B, Kratzschmar J, Haendler B, Schutze N, Regidor P A, Winterhager E. Cyr61, a deregulated gene in endometriosis. Mol Hum Reprod. 2004; 10 399-407 - 2 Cullen T S. The distribution of adenomyoma containing uterine mucosa. Arch Surgery. 1920; 1 215-283 - 3 De Snoo K. Das Problem der Menschwerdung im Lichte der Vergleichenden Geburthilfe. Gustav Fischer, Jena 1942 - 4 Einer-Jensen N. Countercurrent transfer in the ovarian pedicle and its physiological implications. Oxford Rev Reprod Biol. 1988; 10 348-381 - 5 Hull M E, Moghissi K S, Magyar D F, Hayes M F. Comparison of different treatment modalities of endometriosis in infertile women. 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