INFERTILITY AND ADENOMYOSIS

Abstract

The causes of adenomyosis, like other forms of endometriosis, remain unclear, despite numerous hypotheses, opinions, and debates on the subject. Crucially, when discussing its etiology, endometriosis is considered a single disease, focusing on the shared histological characteristics of its external and internal forms. At the same time, a growing number of advocates support a different understanding of adenomyosis—as a completely separate disease, unrelated etiologically and pathogenetically to the external forms of endometriosis. The first group of hypotheses (implantation, dissemination, dysontogenetic, and metaplastic) attempt to elucidate how endometrial elements arrive at their unusual locations; the second group (immune, hormonal, genetic, vascular, apoptosis-associated, and environmental) views endometriosis as a process associated with subtle mechanisms of dysregulation in a woman's body. Given that the uterine cavity is the natural habitat for the endometrium, its invasion of the myometrium is more likely explained by the second group of causes, although this is only speculative. Heterotopic lesions arising in adenomyosis become a source of pain, provoke heavy and prolonged menstrual periods, and reduce endometrial receptivity, contributing to the development of infertility.