ADENOMYOSIS: PATHOPHYSIOLOGY AND TREATMENT

Adenomyosis and endometriosis are closely related disorders and originate from intracavitary endometrium. Oligoclones of endometrial glandular epithelial cells with somatic mutations (e.g., KRAS) and attached stromal cells may give rise to endometriosis if they travel to peritoneal surfaces or the ovary via retrograde menstruation or may be entrapped in the myometrium to give rise to adenomyosis. In both instances, the endometrial cell populations possess survival and growth capabilities conferred by somatic epithelial mutations. Stromal cell epigenetic abnormalities involve excessive local estrogen biosynthesis by aromatase and abnormal estrogen action via estrogen receptor-β, whereas aberrant progesterone receptor expression results in progesterone resistance in both endometriosis and adenomyosis. Endometriosis and adenomyosis have been treated successfully using GnRH analogues and aromatase inhibitors.