BACKGROUND: Adenomyosis is a common gynecological disease with unknown pathogenesis. The HOXA10, HOXA11 and WNT4 genes may play an important role in the pathogenesis of adenomyosis both at the stage of embryonic development and in the postnatal period. The study of their expression in the endometrium of patients with adenomyosis can expand the understanding of the pathogenesis of this disease. AIM: The aim of this work was to study the peculiarity of the WNT4, HOXA10 and HOXA11 gene expression in the eutopic endometrium of patients with isolated adenomyosis. MATERIALS AND METHODS: The study included 38 women: the main group involved patients with isolated adenomyosis established by ultrasound / magnetic resonance imaging (n = 20) and the control group consisted of healthy patients (n = 18). Endometrial sampling was obtained during surgery or by aspiration biopsy at 512 day of the menstrual cycle (proliferative phase) or 2024 day of the menstrual cycle (secretory phase). The expression of the WNT4, HOXA10 and HOXA11 genes in endometrial samples was assessed by a real-time reverse transcription polymerase chain reaction. RESULTS: In the proliferative phase endometrial samples of patients with adenomyosis, a significant increase in the WNT4 (of almost two times), HOXA10 and HOXA11 (of one and a half to two times) gene expression levels was shown compared to the control group. In 88% of patients with adenomyosis, there is a significant increase (up to the level of fourth quartile) in the expression of at least one of these genes, such changes being not typical for the endometrium of women in the control group. In the secretory phase endometrial samples, the expression of the studied genes did not differ from the level characteristic of the corresponding groups in the proliferative phase of the cycle. CONCLUSIONS: The aberrant expression of the WNT4, HOXA10 and HOXA11 genes in the endometrium of patients with adenomyosis indicates a significant role of these genes in the development of the disease and infertility associated with adenomyosis.

BACKGROUND: Patients with endometriosis-associated pain syndrome in combination with anxiety or depression have lower treatment effectiveness and satisfaction with both the disease itself and the pain syndrome compared to patients with pain syndrome but without depression or anxiety. AIM: The aim of the study is to assess the relationship between psychosocial status and endometriosis-associated pain syndrome in patients with different phenotypes of endometriosis using pain assessment scales, psychosocial state assessment scales, and quality of life assessment scales. MATERIALS AND METHODS: We examined 81 patients using a number of questionnaires: Visual Analogue Scale, Numeric Rating Scale, Hospital Anxiety and Depression Scale, Beck Depression Scale, Spielberger State-Trait Anxiety Inventory, and Short Form-36 quality of life assessment. The patients were divided into three groups: isolated adenomyosis (n = 39), adenomyosis combined with external genital endometriosis (n = 21), and the control group (n = 21). RESULTS: Our study has shown that patients with adenomyosis combined with external genital endometriosis had the highest scores on all questionnaires for assessing anxiety and depression, as well as a low quality of life in general, which significantly differed from those in the control group (p 0.05). The results in the group of women with isolated adenomyosis are not so unambiguous and, overall, somewhat better than in the group of patients with adenomyosis combined with external genital endometriosis, but significantly worse compared to the control group. When assessing the severity of dysmenorrhea, higher scores were also found in the group of women with adenomyosis combined with external genital endometriosis: 6.64 2.11 cm (Visual Analogue Scale) and 6.9 2.05 cm (Numeric Rating Scale), while in the group of women with isolated adenomyosis, the scores were 5.29 1.9 cm and 5.83 1.72 cm, respectively (p = 0.028). Women in the control group had no pain syndrome. CONCLUSIONS: Poor mental and physical health scores obtained in this study in women with external genital endometriosis dictate the need for an objective and multicomponent assessment of the psycho-emotional status in patients, followed by complex treatment and team management with related specialists.

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Pelvic pain is one of the most common and significant clinical symptoms of endometriosis. The complex pathogenesis and paradoxical nature of endometriosis-associated pain, its chronicity and centralization, a marked decrease in the quality of life of patients, the lack of an "ideal" and effective remedy with no limitation for all patients, as well as the progressive and recurrent nature of the disease are factors that determine the need for novel, additional therapeutic options. The pain mechanisms in endometriosis and the potential pathogenetic effects of trans-resveratrol and indole-3-carbinol on various aspects of endometriosis-associated pain are addressed based on the literature sources presented in electronic databases PubMed, CyberLeninka, and Google Scholar. The described pharmacological properties of the compounds suggest that the combined use of trans-resveratrol and indole-3-carbinol is a pathogenetically justified and promising treatment for complex endometriosis-associated pain.

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