Endometriosis: a dysfunction and disease of the archimetra

Abstract

Endometriosis is considered primarily a disease of the endometrial-subendometrial unit or archimetra. The clinical picture of endometriosis characterises this disease as a hyperactivation of genuine archimetrial functions such as proliferation, inflammatory defence and peristalsis. While the aetiology of the disease remains to be elucidated, a key event appears to consist in the local production of extraovarian oestrogen by a pathological expression of the P450 aromatase. The starting event may consist in a hyperactivity of the endometrial inflammatory defence, a hyperactivity of the endometrial oxytocin/oxytocin receptor system or in the pathological expression of the P450 aromatase system itself. Regardless of which of these levels the starting event is localized in, they influence each other on both the level of the archimetra and the endometriotic lesions. Locally elevated oestrogen levels inevitably up-regulate the endometrial oxytocin mRNA and increased levels of oxytocin result in uterine hyperperistalsis, increased transtubal seeding of endometrial tissue fragments and finally subfertility and infertility by impairment of the uterine mechanism of rapid and sustained sperm transport. Locally increased levels of oestrogen lead, on both the level of the endometrial-subendometrial unit and the endometriotic lesion, to processes of hyperproliferation. These processes result, on the level of the uterus, in an infiltrative growth of elements of the archimetra into the neometra and, on the level of the endometriotic lesion, in infiltrative endometriosis. There is circumstantial evidence that trauma might be an important initial event that induces the specific biochemical and cellular responses of the archimetra. This model is able to explain both the pleiomorphic appearance of endometriosis and the, up until now, enigmatic infertility associated with mild and moderate endometriosis.

Cine MR imaging of uterine peristalsis in patients with endometriosis

“…Both the sustained and sporadic contractions defined above were not included in the "peristalsis" in this study. However, Leyendecker et al included both coordinated and uncoordinated contractions in his study [6,22]. Such uncoordinated movements were labeled "dysperistalsis" and were observed in women with endometriosis [6,22].…”

“…However, Leyendecker et al included both coordinated and uncoordinated contractions in his study [6,22]. Such uncoordinated movements were labeled "dysperistalsis" and were observed in women with endometriosis [6,22]. In these studies, "dysperistalsis" was defined as: (1) contractions originating in the middle portion of the uterus and spreading simultaneously to the fundus and the cervix; (2) contractions starting simultaneously at different sites, creating a convulsive appearance of uterine activity, with some waves vanishing before reaching the uterine fundus [6].…”

Patients with adenomyosis are more likely to have deep endometriosis

“…Adenomyosis is a gynecological disease characterized by the presence of endometrial glands and stroma in the myometrium, generally covered by smooth muscle hyperplasia [1][2][3]. Its prevalence is unclear, ranging from 15 % to 20 % [4][5][6] and reaching coefficients of up to 90 % when infertile patients are taken into consideration [7].…”

Analytical Hypotheses on Possible Etiology and Types of Endometriosis

“…Over a decade ago, Leyendecker et al [44] were the first to submit that the cause or causes of endometriosis and adenomyosis may be unpretentious and closely linked with some physiologic processes of reproduction. They argued that trauma followed by tissue-specific inflammatory response and repair involving specific, albeit physiological, cellular, biochemical and molecular mechanisms may be considered the major events in the development of endometriosis.…”