Mechanisms and Pathogenesis of Adenomyosis

Margherita Rossi, Silvia Vannuccini, Tommaso Capezzuoli, Massimiliano Fambrini, Valentina Vannuzzi, Chiara Donati, Felice Petraglia
In: Current Obstetrics and Gynecology Reports · 2022 · vol. 11(2) , pp. 95–102 · doi:10.1007/s13669-022-00326-7 · W4221084833
article OA: hybrid CC0 ⤵ 14 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review synthesizes current knowledge on adenomyosis pathogenesis, detailing proposed mechanisms including endometrial invagination, stem cell origins, hormonal imbalances, inflammation, neuroangiogenesis, and fibrosis.

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

This paper is a 2022 narrative review that synthesizes current concepts and controversies about how adenomyosis develops, focusing on proposed origins (tissue injury and repair invagination, displaced embryonic Müllerian remnants/adult stem cells, and “invasion from outside to inside”). It summarizes evidence linking adenomyosis pathogenesis to hormone signaling imbalance (local estrogen via aromatase and altered steroid receptor/processing pathways), and to inflammatory, neuroangiogenic, fibrotic, and cell proliferation/differentiation processes, while describing key caveats that the field remains under investigation and that multiple mechanisms are still being worked out. The review notes that adenomyosis is a benign estrogen-dependent condition characterized by endometrial basalis glands and stroma infiltrating the myometrium through an altered junctional zone, and frames clinical features including dysmenorrhea, abnormal uterine bleeding, and infertility in relation to these mechanisms. This paper is centrally about adenomyosis — it provides a comprehensive overview of mechanisms and theories for its pathogenesis.

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Abstract

Abstract Purpose of the Review The purpose of this review is to provide a synopsis of all the mechanisms involved in the pathogenesis of adenomyosis. It will summarize recent advances in the field, discussing current controversies, and considering potential future directions. Recent Findings Adenomyosis pathogenesis is still a topic under investigation, however advancements in the understanding of disease development and mechanisms have been made. New data coming from new next generation sequencing-based studies and more-in-depth acquisitions on sex hormones imbalance, neuroangiogenesis, inflammation, fibrosis and cell proliferation have been obtained. Summary Adenomyosis is a uterine disorder that affects women of reproductive age, characterized by a benign invasion of the endometrium basalis (glands and stroma) within the myometrium. So far, three theories for the pathophysiology of adenomyosis have been proposed: An invagination of the endometrial basalis into the myometrium by tissue injury and repair. The development from adult stem cells or displaced embryonic müllerian remnants. An “invasion from outside to inside”. In order to invade and develop, endometrial cells require a series of pathogenetic mechanisms which drive to adenomyosis. Altered sex steroids hormones receptors may be the primary event which causes increased endometrial cell proliferations and differentiation from epithelial to mesenchymal cells. Once invaded the myometrium, an inflammatory reaction is displayed, probably driven by local immune changes. The processes of neuroangiogenesis and fibrosis are also involved in the adenomyosis development and may explain some of the associated clinical symptoms (dysmenorrhea, abnormal uterine bleeding, and infertility).

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Condition tags

adenomyosisdysmenorrheainfertility

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