Santulli Pietro, Vannuccini Silvia, Bourdon Mathilde, Chapron Charles, Petraglia Felice
Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France.; Department of Gynecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Paris, France.
Department of Experimental, Clinical and Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.; Department of Maternal and Child Health, Careggi University Hospital, Florence, Italy.
Reprod Biomed Online. 2025 Apr;50(4):104837. doi: 10.1016/j.rbmo.2025.104837.
Adenomyosis, a menstruation-related uterine disorder, refers to the presence of endometrial stroma and glands within the myometrium and is typically observed in reproductive-age women. The pathogenesis explaining the migration, persistence, proliferation and differentiation of ectopic endometrial cells includes a genetic and epigenetic background, an oestrogen/progesterone receptor imbalance and an inflammatory reaction driven by local immune dysfunction, along with fibrosis and neuroangiogenesis within the myometrium. In the past, it was thought that adenomyosis almost exclusively affected multiparous women after 40 years of age and the diagnosis was generally confirmed upon hysterectomy. Nowadays, using imaging techniques such as transvaginal ultrasonography and magnetic resonance imaging, adenomyosis is increasingly identified in young women with dysmenorrhoea, dyspareunia, abnormal uterine bleeding and heavy menstrual bleeding, and also in infertile patients. Furthermore, adenomyosis often coexists with other gynaecological conditions, such as endometriosis and uterine fibroids. Despite the improvement of non-invasive diagnostic tools, the awareness of the condition is still poor and the diagnosis is often missed, due also to a heterogeneity in clinical presentation and imaging criteria. In addition, medical and surgical management do not follow shared recommendations, even though adenomyosis requires a lifelong management plan, including pain and bleeding control, fertility preservation and pregnancy complications.
子宫腺肌病是一种与月经相关的子宫疾病，指子宫肌层内存在子宫内膜间质和腺体，多见于育龄期女性。解释异位子宫内膜细胞迁移、存留、增殖和分化的发病机制包括遗传和表观遗传背景、雌激素/孕激素受体失衡以及局部免疫功能障碍驱动的炎症反应，同时还涉及子宫肌层内的纤维化和神经血管生成。过去，人们认为子宫腺肌病几乎只影响40岁以上的经产妇，诊断通常在子宫切除术后得以证实。如今，通过经阴道超声检查和磁共振成像等影像学技术，子宫腺肌病在患有痛经、性交困难、异常子宫出血和月经过多的年轻女性以及不孕患者中越来越多地被发现。此外，子宫腺肌病常与其他妇科疾病并存，如子宫内膜异位症和子宫肌瘤。尽管非侵入性诊断工具有所改进，但由于临床表现和影像学标准存在异质性，对该病的认知仍然不足，诊断常常被漏诊。此外，药物和手术治疗并不遵循共同的建议，尽管子宫腺肌病需要终身管理计划，包括控制疼痛和出血、保留生育能力以及处理妊娠并发症。
