Page 69 - ESHRE2019

Uterine autotraumatization
Leyendecker G. et al. Arch Gynecol Obstet 2014
Uterine peristalsis and hyperperistalsis constitutes the main mechanism.
Strongest power at the upper level of the uterine cavity.
Highest density of OTR (oxytocin receptors)
Most frequent localisation of adenomyotic lesions in upper two thirds of uterine cavity
Phenotypic characterization of adenomyosis occurring at the inner and outer myometrium.
Yohei Kishi et al. Plos one Dec. 2017
Subtype II adenomyosis
• The vast majority of Subtype II adenomyosis patients have
pelvic endometriosis, which are localized at the outer
myometrium where they have a direct connection with peritoneum
• Associated rectovaginal adenomyosis
• Supposed to have arisen under the direct and indirect influence from
pelvic endometriosis (TGF‐β1 Increased in peritoneum endometriosis)􏰀
• suspect that TGF‐ β1 induced de‐differentiation of the outer myometrial SMCs may be involved in the fibrotic process of Subtype II adenomyosis.
64
PRECONGRESS COURSE 11 I VIENNA, AUSTRIA – 23 JUNE 2019 67