Société de Recherche Pour l'Infertilité, 1150 Brussels, Belgium.
Université Catholique de Louvain, 1200 Brussels, Belgium.
Int J Environ Res Public Health. 2021 Sep 22;18(19):9941. doi: 10.3390/ijerph18199941.
Uterine adenomyosis is a common chronic disorder frequently encountered in reproductive-age women, causing heavy menstrual bleeding, intense pelvic pain, and infertility. Despite its high prevalence, its etiopathogenesis is not yet fully understood, so there are currently no specific drugs to treat the disease. A number of dysregulated mechanisms are believed to contribute to adenomyosis development and symptoms, including sex steroid signaling, endometrial proliferation and invasiveness, and aberrant immune response. Abnormal sex steroid signaling, particularly hyperestrogenism and subsequent progesterone resistance, are known to play a pivotal role in its pathogenesis, which is why various antiestrogenic agents have been used to manage adenomyosis-related symptoms. Among them, gonadotropin-releasing hormone (GnRH) antagonists are swiftly gaining ground, with recent studies reporting efficient lesion regression and symptom alleviation. The aim of the present review is to compile available information on the pathogenesis of adenomyosis, explore the etiology and mechanisms of hyperestrogenism, and discuss the potential of antiestrogenic therapies for treating the disease and improving patient quality of life.
子宫腺肌病是一种常见的慢性疾病，常发生在育龄妇女中，导致月经过多、剧烈的盆腔疼痛和不孕。尽管其发病率很高，但发病机制尚不完全清楚，因此目前尚无专门治疗该疾病的药物。许多失调的机制被认为有助于腺肌病的发展和症状，包括性激素信号、子宫内膜增殖和侵袭性以及异常的免疫反应。异常的性激素信号，特别是雌激素过多和随后的孕激素抵抗，被认为在其发病机制中起着关键作用，这就是为什么各种抗雌激素药物被用于管理与腺肌病相关的症状。其中，促性腺激素释放激素（GnRH）拮抗剂迅速崭露头角，最近的研究报告称其能有效消退病变和缓解症状。本综述的目的是汇集有关腺肌病发病机制的现有信息，探讨雌激素过多的病因和机制，并讨论抗雌激素治疗治疗该疾病和提高患者生活质量的潜力。
