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Role of Hormones in Common Benign Uterine Lesions: Endometrial Polyps, Leiomyomas, and Adenomyosis

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Hormonal Pathology of the Uterus

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1242))

Abstract

Leiomyoma, adenomyosis, and endometrial polyps are benign uterine disorders which seem to develop in the context of hormonal imbalances, due to steroid hormones, estrogen and progesterone, in association with various factors ranging from genetic factors to modifiable lifestyle factors. A growing body of evidence suggests that those hormones and their receptors are key modulators in the genesis and the growth of those pathologic entities. Further studies are required to understand their involvement in the pathogenesis of those lesions and their link to other factors such as extracellular matrix components, growth factors, chemokines, cytokines, and tissue repair mechanisms.

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References

  1. Deneris A. PALM-COEIN nomenclature for abnormal uterine bleeding. J Midwifery Womens Health. 2016;61:376–9.

    Article  PubMed  Google Scholar 

  2. Munro MG. Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity. Fertil Steril. 2019;111:629–40.

    Article  PubMed  Google Scholar 

  3. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94:435–8.

    Article  CAS  PubMed  Google Scholar 

  4. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100–7.

    Article  PubMed  Google Scholar 

  5. Tiltman AJ. Smooth muscle neoplasms of the uterus. Curr Opin Obstet Gynecol. 1997;9:48–51.

    Article  CAS  PubMed  Google Scholar 

  6. Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM. Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med. 1996;41:483–90.

    CAS  PubMed  Google Scholar 

  7. Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90:967–73.

    Article  CAS  PubMed  Google Scholar 

  8. Munro MG, HOD C, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113:3–13.

    Article  PubMed  Google Scholar 

  9. Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect. 2003;111:1037–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Huyck KL, Panhuysen CIM, Cuenco KT, Zhang J, Goldhammer H, Jones ES, et al. The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyomata among affected sisters. Am J Obstet Gynecol. 2008;198:168.e1–9.

    Article  Google Scholar 

  11. Peddada SD, Laughlin SK, Miner K, Guyon J-P, Haneke K, Vahdat HL, et al. Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci U S A. 2008;105:19887–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206:211.e1–9.

    Article  Google Scholar 

  13. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG Int J Obstet Gynaecol. 2017;124:1501–12.

    Article  CAS  Google Scholar 

  14. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and risk factors of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2018;46:3–11.

    Article  PubMed  Google Scholar 

  15. Canevari RA, Pontes A, Rosa FE, Rainho CA, Rogatto SR. Independent clonal origin of multiple uterine leiomyomas that was determined by X chromosome inactivation and microsatellite analysis. Am J Obstet Gynecol. 2005;193:1395–403.

    Article  PubMed  Google Scholar 

  16. Zhang P, Zhang C, Hao J, Sung CJ, Quddus MR, Steinhoff MM, et al. Use of X-chromosome inactivation pattern to determine the clonal origins of uterine leiomyoma and leiomyosarcoma. Hum Pathol. 2006;37:1350–6.

    Article  CAS  PubMed  Google Scholar 

  17. Ono M, Qiang W, Serna VA, Yin P, Coon JS, Navarro A, et al. Role of stem cells in human uterine leiomyoma growth. PLoS One. 2012;7:e36935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Mäkinen N, Mehine M, Tolvanen J, Kaasinen E, Li Y, Lehtonen HJ, et al. MED12, the mediator complex subunit 12 gene, is mutated at high frequency in uterine leiomyomas. Science. 2011;334:252–5.

    Article  PubMed  CAS  Google Scholar 

  19. Markowski DN, Bartnitzke S, Löning T, Drieschner N, Helmke BM, Bullerdiek J. MED12 mutations in uterine fibroids—their relationship to cytogenetic subgroups. Int J Cancer. 2012;131:1528–36.

    Article  CAS  PubMed  Google Scholar 

  20. Kämpjärvi K, Mäkinen N, Mehine M, Välipakka S, Uimari O, Pitkänen E, et al. MED12 mutations and FH inactivation are mutually exclusive in uterine leiomyomas. Br J Cancer. 2016;114:1405–11.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Launonen V, Vierimaa O, Kiuru M, Isola J, Roth S, Pukkala E, et al. Inherited susceptibility to uterine leiomyomas and renal cell cancer. Proc Natl Acad Sci U S A. 2001;98:3387–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Tomlinson IPM, Alam NA, Rowan AJ, Barclay E, Jaeger EEM, Kelsell D, et al. Germline mutations in FH predispose to dominantly inherited uterine fibroids, skin leiomyomata and papillary renal cell cancer. Nat Genet. 2002;30:406–10.

    Article  CAS  PubMed  Google Scholar 

  23. Kovács KA, Oszter A, Göcze PM, Környei JL, Szabó I. Comparative analysis of cyclin D1 and oestrogen receptor (alpha and beta) levels in human leiomyoma and adjacent myometrium. Mol Hum Reprod. 2001;7:1085–91.

    Article  PubMed  Google Scholar 

  24. Ying Z, Weiyuan Z. Dual actions of progesterone on uterine leiomyoma correlate with the ratio of progesterone receptor A:B. Gynecol Endocrinol. 2009;25:520–3.

    Article  CAS  PubMed  Google Scholar 

  25. Viville B, Charnock-Jones DS, Sharkey AM, Wetzka B, Smith SK. Distribution of the A and B forms of the progesterone receptor messenger ribonucleic acid and protein in uterine leiomyomata and adjacent myometrium. Hum Reprod. 1997;12:815–22.

    Article  CAS  PubMed  Google Scholar 

  26. Benassayag C, Leroy MJ, Rigourd V, Robert B, Honoré JC, Mignot TM, et al. Estrogen receptors (ERalpha/ERbeta) in normal and pathological growth of the human myometrium: pregnancy and leiomyoma. Am J Phys. 1999;276:E1112–8.

    CAS  Google Scholar 

  27. Bulun SE. Uterine fibroids. N Engl J Med. 2013;369:1344–55.

    Article  CAS  PubMed  Google Scholar 

  28. Tai C-T, Lin W-C, Chang W-C, Chiu T-H, Chen GTC. Classical cadherin and catenin expression in normal myometrial tissues and uterine leiomyomas. Mol Reprod Dev. 2003;64:172–8.

    Article  CAS  PubMed  Google Scholar 

  29. Tanwar PS, Lee H-J, Zhang L, Zukerberg LR, Taketo MM, Rueda BR, et al. Constitutive activation of beta-catenin in uterine stroma and smooth muscle leads to the development of mesenchymal tumors in mice. Biol Reprod. 2009;81:545–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Mosimann C, Hausmann G, Basler K. Beta-catenin hits chromatin: regulation of Wnt target gene activation. Nat Rev Mol Cell Biol. 2009;10:276–86.

    Article  CAS  PubMed  Google Scholar 

  31. Arici A, Sozen I. Transforming growth factor-beta3 is expressed at high levels in leiomyoma where it stimulates fibronectin expression and cell proliferation. Fertil Steril. 2000;73:1006–11.

    Article  CAS  PubMed  Google Scholar 

  32. Parsanezhad ME, Azmoon M, Alborzi S, Rajaeefard A, Zarei A, Kazerooni T, et al. A randomized, controlled clinical trial comparing the effects of aromatase inhibitor (letrozole) and gonadotropin-releasing hormone agonist (triptorelin) on uterine leiomyoma volume and hormonal status. Fertil Steril. 2010;93:192–8.

    Article  CAS  PubMed  Google Scholar 

  33. Kastner P, Krust A, Turcotte B, Stropp U, Tora L, Gronemeyer H, et al. Two distinct estrogen-regulated promoters generate transcripts encoding the two functionally different human progesterone receptor forms A and B. EMBO J. 1990;9:1603–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kim JJ, Sefton EC. The role of progesterone signaling in the pathogenesis of uterine leiomyoma. Mol Cell Endocrinol. 2012;358:223–31.

    Article  CAS  PubMed  Google Scholar 

  35. Donnez J, Tomaszewski J, Vázquez F, Bouchard P, Lemieszczuk B, Baró F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 2012;366:421–32.

    Article  CAS  PubMed  Google Scholar 

  36. Donnez J, Tatarchuk TF, Bouchard P, Puscasiu L, Zakharenko NF, Ivanova T, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. 2012;366:409–20.

    Article  CAS  PubMed  Google Scholar 

  37. Ishikawa H, Ishi K, Serna VA, Kakazu R, Bulun SE, Kurita T. Progesterone is essential for maintenance and growth of uterine leiomyoma. Endocrinology. 2010;151:2433–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ohara N, Morikawa A, Chen W, Wang J, DeManno DA, Chwalisz K, et al. Comparative effects of SPRM asoprisnil (J867) on proliferation, apoptosis, and the expression of growth factors in cultured uterine leiomyoma cells and normal myometrial cells. Reprod Sci. 2007;14:20–7.

    Article  CAS  PubMed  Google Scholar 

  39. Chen W, Ohara N, Wang J, Xu Q, Liu J, Morikawa A, et al. A novel selective progesterone receptor modulator asoprisnil (J867) inhibits proliferation and induces apoptosis in cultured human uterine leiomyoma cells in the absence of comparable effects on myometrial cells. J Clin Endocrinol Metab. 2006;91:1296–304.

    Article  CAS  PubMed  Google Scholar 

  40. Hoekstra AV, Sefton EC, Berry E, Lu Z, Hardt J, Marsh E, et al. Progestins activate the AKT pathway in leiomyoma cells and promote survival. J Clin Endocrinol Metab. 2009;94:1768–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Bagaria M, Suneja A, Vaid NB, Guleria K, Mishra K. Low-dose mifepristone in treatment of uterine leiomyoma: a randomised double-blind placebo-controlled clinical trial. Aust N Z J Obstet Gynaecol. 2009;49:77–83.

    Article  PubMed  Google Scholar 

  42. Williams ARW, Critchley HOD, Osei J, Ingamells S, Cameron IT, Han C, et al. The effects of the selective progesterone receptor modulator asoprisnil on the morphology of uterine tissues after 3 months treatment in patients with symptomatic uterine leiomyomata. Hum Reprod. 2007;22:1696–704.

    Article  CAS  PubMed  Google Scholar 

  43. Engman M, Granberg S, Williams ARW, Meng CX, Lalitkumar PGL, Gemzell-Danielsson K. Mifepristone for treatment of uterine leiomyoma. A prospective randomized placebo controlled trial. Hum Reprod. 2009;24:1870–9.

    Article  CAS  PubMed  Google Scholar 

  44. Eisinger SH, Meldrum S, Fiscella K, le Roux HD, Guzick DS. Low-dose mifepristone for uterine leiomyomata. Obstet Gynecol. 2003;101:243–50.

    CAS  PubMed  Google Scholar 

  45. Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun J-L, De Jesus I, et al. Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2012;165:156–64.

    Article  PubMed  Google Scholar 

  46. Gliklich RE, Leavy MB, Velentgas P, Campion DM, Mohr P, Sabharwal R, et al. Identification of Future Research Needs in the Comparative Management of Uterine Fibroid Disease. Effective Health Care Program. https://effectivehealthcare.ahrq.gov/topics/uterine-fibroids-2010/research

  47. Lethaby A, Duckitt K, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013;(1):CD000400.

    Google Scholar 

  48. Mutter GL, Bergeron C, Deligdisch L, Ferenczy A, Glant M, Merino M, et al. The spectrum of endometrial pathology induced by progesterone receptor modulators. Mod Pathol. 2008;21:591–8.

    Article  CAS  PubMed  Google Scholar 

  49. Tristan M, Orozco LJ, Steed A, Ramírez-Morera A, Stone P. Mifepristone for uterine fibroids. Cochrane Database Syst Rev. 2012;(8):CD007687.

    Google Scholar 

  50. Shen Q, Hua Y, Jiang W, Zhang W, Chen M, Zhu X. Effects of mifepristone on uterine leiomyoma in premenopausal women: a meta-analysis. Fertil Steril. 2013;100:1722–6.e1–10.

    Article  CAS  PubMed  Google Scholar 

  51. Sangkomkamhang US, Lumbiganon P, Laopaiboon M, Mol BWJ. Progestogens or progestogen-releasing intrauterine systems for uterine fibroids. Cochrane Database Syst Rev. 2013;(2):CD008994.

    Google Scholar 

  52. Steinauer J, Pritts EA, Jackson R, Jacoby AF. Systematic review of mifepristone for the treatment of uterine leiomyomata. Obstet Gynecol. 2004;103:1331–6.

    Article  CAS  PubMed  Google Scholar 

  53. Muzii L, Boni T, Bellati F, Marana R, Ruggiero A, Zullo MA, et al. GnRH analogue treatment before hysteroscopic resection of submucous myomas: a prospective, randomized, multicenter study. Fertil Steril. 2010;94:1496–9.

    Article  CAS  PubMed  Google Scholar 

  54. Lethaby AE, Vollenhoven BJ. An evidence-based approach to hormonal therapies for premenopausal women with fibroids. Best Pract Res Clin Obstet Gynaecol. 2008;22:307–31.

    Article  PubMed  Google Scholar 

  55. Laughlin-Tommaso SK, Stewart EA. Moving toward individualized medicine for uterine leiomyomas. Obstet Gynecol. 2018;132:961–71.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Flierman PA, Oberyé JJL, van der Hulst VPM, de Blok S. Rapid reduction of leiomyoma volume during treatment with the GnRH antagonist ganirelix. BJOG Int J Obstet Gynaecol. 2005;112:638–42.

    Article  CAS  Google Scholar 

  57. Palomba S, Orio F, Morelli M, Russo T, Pellicano M, Zupi E, et al. Raloxifene administration in premenopausal women with uterine leiomyomas: a pilot study. J Clin Endocrinol Metab. 2002;87:3603–8.

    Article  CAS  PubMed  Google Scholar 

  58. Palomba S, Russo T, Orio F, Tauchmanovà L, Zupi E, Panici PLB, et al. Effectiveness of combined GnRH analogue plus raloxifene administration in the treatment of uterine leiomyomas: a prospective, randomized, single-blind, placebo-controlled clinical trial. Hum Reprod. 2002;17:3213–9.

    Article  CAS  PubMed  Google Scholar 

  59. Hilário SG, Bozzini N, Borsari R, Baracat EC. Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients. Fertil Steril. 2009;91:240–3.

    Article  PubMed  CAS  Google Scholar 

  60. Hartmann KE, Fonnesbeck C, Surawicz T, Krishnaswami S, Andrews JC, Wilson JE, et al. Management of Uterine Fibroids [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); http://www.ncbi.nlm.nih.gov/books/NBK537742/

  61. Hehenkamp WJK, Volkers NA, Donderwinkel PFJ, de Blok S, Birnie E, Ankum WM, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol. 2005;193:1618–29.

    Article  PubMed  Google Scholar 

  62. Peregrino PFM, de Lorenzo Messina M, dos Santos Simões R, Soares-Júnior JM, Baracat EC. Review of magnetic resonance-guided focused ultrasound in the treatment of uterine fibroids. Clinics. 2017;72:637–41.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Brucker SY, Hahn M, Kraemer D, Taran FA, Isaacson KB, Krämer B. Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy. Int J Gynaecol Obstet. 2014;125:261–5.

    Article  PubMed  Google Scholar 

  64. Lee BB, Yu SP. Radiofrequency ablation of uterine fibroids: a review. Curr Obstet Gynecol Rep. 2016;5:318–24.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Krämer B, Hahn M, Taran F-A, Kraemer D, Isaacson KB, Brucker SY. Interim analysis of a randomized controlled trial comparing laparoscopic radiofrequency volumetric thermal ablation of uterine fibroids with laparoscopic myomectomy. Int J Gynaecol Obstet. 2016;133:206–11.

    Article  PubMed  Google Scholar 

  66. Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primer. 2016;2:16043.

    Article  Google Scholar 

  67. Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus—revisited. Am J Obstet Gynecol. 1972;112:583–93.

    Article  CAS  PubMed  Google Scholar 

  68. Seidman JD, Kjerulff KH. Pathologic findings from the Maryland Women’s Health Study: practice patterns in the diagnosis of adenomyosis. Int J Gynecol Pathol. 1996;15:217–21.

    Article  CAS  PubMed  Google Scholar 

  69. Pontis A, D’Alterio MN, Pirarba S, de Angelis C, Tinelli R, Angioni S. Adenomyosis: a systematic review of medical treatment. Gynecol Endocrinol. 2016;32:696–700.

    Article  CAS  PubMed  Google Scholar 

  70. Hever A, Roth RB, Hevezi PA, Lee J, Willhite D, White EC, et al. Molecular characterization of human adenomyosis. Mol Hum Reprod. 2006;12:737–48.

    Article  CAS  PubMed  Google Scholar 

  71. Farquhar C, Brosens I. Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:603–16.

    Article  PubMed  Google Scholar 

  72. Bazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018;109:389–97.

    Article  PubMed  Google Scholar 

  73. Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril. 2014;101:472–87.

    Article  PubMed  Google Scholar 

  74. Kishi Y, Suginami H, Kuramori R, Yabuta M, Suginami R, Taniguchi F. Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol. 2012;207:114.e1–7.

    Article  Google Scholar 

  75. Taran FA, Stewart EA, Brucker S. Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd. 2013;73:924–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo S-W, et al. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017;35:592–601.

    Article  CAS  PubMed  Google Scholar 

  77. Bergeron C, Amant F, Ferenczy A. Pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:511–21.

    Article  PubMed  Google Scholar 

  78. Brosens JJ, de Souza NM, Barker FG. Uterine junctional zone: function and disease. Lancet Lond Engl. 1995;346:558–60.

    Article  CAS  Google Scholar 

  79. Takahashi K, Nagata H, Kitao M. Clinical usefulness of determination of estradiol level in the menstrual blood for patients with endometriosis. Nihon Sanka Fujinka Gakkai Zasshi. 1989;41:1849–50.

    CAS  PubMed  Google Scholar 

  80. Tong X, Li Z, Wu Y, Fu X, Zhang Y, Fan H. COMT 158G/A and CYP1B1 432C/G polymorphisms increase the risk of endometriosis and adenomyosis: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;179:17–21.

    Article  CAS  PubMed  Google Scholar 

  81. Wang Y, Qu Y, Song W. Genetic variation in COX-2 -1195 and the risk of endometriosis and adenomyosis. Clin Exp Obstet Gynecol. 2015;42:168–72.

    PubMed  Google Scholar 

  82. Nie J, Liu X, Guo S-W. Promoter hypermethylation of progesterone receptor isoform B (PR-B) in adenomyosis and its rectification by a histone deacetylase inhibitor and a demethylation agent. Reprod Sci. 2010;17:995–1005.

    Article  CAS  Google Scholar 

  83. Mehasseb MK, Panchal R, Taylor AH, Brown L, Bell SC, Habiba M. Estrogen and progesterone receptor isoform distribution through the menstrual cycle in uteri with and without adenomyosis. Fertil Steril. 2011;95:2228–35, 2235.e1.

    Article  CAS  PubMed  Google Scholar 

  84. Cohen I, Shapira J, Beyth Y, Bernheim J, Tepper R, Cordoba M, et al. Estrogen and progesterone receptors of adenomyosis in postmenopausal breast cancer patients treated with tamoxifen. Gynecol Obstet Investig. 1998;45:126–31.

    Article  CAS  Google Scholar 

  85. McCluggage WG, Desai V, Manek S. Tamoxifen-associated postmenopausal adenomyosis exhibits stromal fibrosis, glandular dilatation and epithelial metaplasias. Histopathology. 2000;37:340–6.

    Article  CAS  PubMed  Google Scholar 

  86. Leyendecker G, Wildt L. A new concept of endometriosis and adenomyosis: tissue injury and repair (TIAR). Horm Mol Biol Clin Investig. 2011;5:125–42.

    CAS  PubMed  Google Scholar 

  87. García-Solares J, Donnez J, Donnez O, Dolmans M-M. Pathogenesis of uterine adenomyosis: invagination or metaplasia? Fertil Steril. 2018;109:371–9.

    Article  PubMed  Google Scholar 

  88. Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet. 2009;280:529–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Riggs JC, Lim EK, Liang D, Bullwinkel R. Cesarean section as a risk factor for the development of adenomyosis uteri. J Reprod Med. 2014;59:20–4.

    PubMed  Google Scholar 

  90. Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG. Risk factors for adenomyosis. Hum Reprod. 1997;12:1275–9.

    Article  CAS  PubMed  Google Scholar 

  91. Templeman C, Marshall SF, Ursin G, Horn-Ross PL, Clarke CA, Allen M, et al. Adenomyosis and endometriosis in the California Teachers Study. Fertil Steril. 2008;90:415–24.

    Article  PubMed  Google Scholar 

  92. Taran FA, Weaver AL, Coddington CC, Stewart EA. Understanding adenomyosis: a case control study. Fertil Steril. 2010;94:1223–8.

    Article  PubMed  Google Scholar 

  93. Gargett CE. Uterine stem cells: what is the evidence? Hum Reprod Update. 2007;13:87–101.

    Article  CAS  PubMed  Google Scholar 

  94. Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update. 1998;4:312–22.

    Article  CAS  PubMed  Google Scholar 

  95. Chan RWS, Schwab KE, Gargett CE. Clonogenicity of human endometrial epithelial and stromal cells. Biol Reprod. 2004;70:1738–50.

    Article  CAS  PubMed  Google Scholar 

  96. Gargett CE, Schwab KE, Deane JA. Endometrial stem/progenitor cells: the first 10 years. Hum Reprod Update. 2016;22:137–63.

    Article  CAS  PubMed  Google Scholar 

  97. Ibrahim MG, Chiantera V, Frangini S, Younes S, Köhler C, Taube ET, et al. Ultramicro-trauma in the endometrial-myometrial junctional zone and pale cell migration in adenomyosis. Fertil Steril. 2015;104:1475–1483.e3.

    Article  CAS  PubMed  Google Scholar 

  98. Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Research 2019, 8(F1000 Faculty Rev):283 Last updated: 17 JUL 2019. https://f1000research.com/articles/8-28

  99. Angioni S, Pontis A, Dessole M, Surico D, De Cicco Nardone C, Melis I. Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery. Arch Gynecol Obstet. 2015;291:363–70.

    Article  CAS  PubMed  Google Scholar 

  100. Fawzy M, Mesbah Y. Comparison of dienogest versus triptorelin acetate in premenopausal women with adenomyosis: a prospective clinical trial. Arch Gynecol Obstet. 2015;292:1267–71.

    Article  CAS  PubMed  Google Scholar 

  101. Igarashi M. A new therapy for pelvic endometriosis and uterine adenomyosis: local effect of vaginal and intrauterine danazol application. Asia Oceania J Obstet Gynaecol. 1990;16:1–12.

    Article  CAS  PubMed  Google Scholar 

  102. Luisi S, Razzi S, Lazzeri L, Bocchi C, Severi FM, Petraglia F. Efficacy of vaginal danazol treatment in women with menorrhagia during fertile age. Fertil Steril. 2009;92:1351–4.

    Article  CAS  PubMed  Google Scholar 

  103. Muneyyirci-Delale O, Chandrareddy A, Mankame S, Osei-Tutu N, von Gizycki H. Norethindrone acetate in the medical management of adenomyosis. Pharmaceuticals. 2012;5:1120–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Sasagawa S, Shimizu Y, Kami H, Takeuchi T, Mita S, Imada K, et al. Dienogest is a selective progesterone receptor agonist in transactivation analysis with potent oral endometrial activity due to its efficient pharmacokinetic profile. Steroids. 2008;73:222–31.

    Article  CAS  PubMed  Google Scholar 

  105. Takebayashi T, Fujino Y, Umesaki N, Ogita S. Danazol suspension injected into the uterine cervix of patients with adenomyosis and myoma. Preliminary study. Gynecol Obstet Invest. 1995;39:207–11.

    Article  CAS  PubMed  Google Scholar 

  106. Tosti C, Vannuccini S, Troìa L, Luisi S, Centini G, Lazzeri L, et al. Long-term vaginal danazol treatment in fertile age women with adenomyosis. J Endometr Pelvic Pain Disord. 2017;9:39–43.

    Article  Google Scholar 

  107. Zhang X, Yuan H, Deng L, Hu F, Ma J, Lin J. Evaluation of the efficacy of a danazol-loaded intrauterine contraceptive device on adenomyosis in an ICR mouse model. Hum Reprod. 2008;23:2024–30.

    Article  CAS  PubMed  Google Scholar 

  108. Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68:426–9.

    Article  CAS  PubMed  Google Scholar 

  109. Fraser IS. Non-contraceptive health benefits of intrauterine hormonal systems. Contraception. 2010;82:396–403.

    Article  PubMed  Google Scholar 

  110. Sabbioni L, Petraglia F, Luisi S. Non-contraceptive benefits of intrauterine levonorgestrel administration: why not? Gynecol Endocrinol. 2017;33:822–9.

    Article  CAS  PubMed  Google Scholar 

  111. Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999;60:173–5.

    Article  CAS  PubMed  Google Scholar 

  112. Ozdegirmenci O, Kayikcioglu F, Akgul MA, Kaplan M, Karcaaltincaba M, Haberal A, et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril. 2011;95:497–502.

    Article  CAS  PubMed  Google Scholar 

  113. Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010;(1):CD001751.

    Google Scholar 

  114. Brosens I, Gordts S, Habiba M, Benagiano G. Uterine cystic adenomyosis: a disease of younger women. J Pediatr Adolesc Gynecol. 2015;28:420–6.

    Article  PubMed  Google Scholar 

  115. Gordts S, Campo R, Brosens I. Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis. Gynecol Surg. 2014;11:273–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Kriplani A, Mahey R, Agarwal N, Bhatla N, Yadav R, Singh MK. Laparoscopic management of juvenile cystic adenomyoma: four cases. J Minim Invasive Gynecol. 2011;18:343–8.

    Article  PubMed  Google Scholar 

  117. Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand. 2017;96:715–26.

    Article  PubMed  Google Scholar 

  118. Pepas L, Deguara C, Davis C. Update on the surgical management of adenomyosis. Curr Opin Obstet Gynecol. 2012;24:259–64.

    Article  PubMed  Google Scholar 

  119. Kim K-R, Peng R, Ro JY, Robboy SJ. A diagnostically useful histopathologic feature of endometrial polyp: the long axis of endometrial glands arranged parallel to surface epithelium. Am J Surg Pathol. 2004;28:1057–62.

    Article  PubMed  Google Scholar 

  120. de Rijk SR, Steenbergen ME, Nieboer TE, Coppus SF. Atypical endometrial polyps and concurrent endometrial cancer: a systematic review. Obstet Gynecol. 2016;128:519–25.

    Article  PubMed  Google Scholar 

  121. Kelly P, Dobbs SP, McCluggage WG. Endometrial hyperplasia involving endometrial polyps: report of a series and discussion of the significance in an endometrial biopsy specimen. BJOG Int J Obstet Gynaecol. 2007;114:944–50.

    Article  CAS  Google Scholar 

  122. Wong M, Crnobrnja B, Liberale V, Dharmarajah K, Widschwendter M, Jurkovic D. The natural history of endometrial polyps. Hum Reprod. 2017;32:340–5.

    Article  CAS  PubMed  Google Scholar 

  123. Fletcher JA, Pinkus JL, Lage JM, Morton CC, Pinkus GS. Clonal 6p21 rearrangement is restricted to the mesenchymal component of an endometrial polyp. Genes Chromosomes Cancer. 1992;5:260–3.

    Article  CAS  PubMed  Google Scholar 

  124. Dal Cin P, Vanni R, Marras S, Moerman P, Kools P, Andria M, et al. Four cytogenetic subgroups can be identified in endometrial polyps. Cancer Res. 1995;55:1565–8.

    CAS  PubMed  Google Scholar 

  125. Tallini G, Vanni R, Manfioletti G, Kazmierczak B, Faa G, Pauwels P, et al. HMGI-C and HMGI(Y) immunoreactivity correlates with cytogenetic abnormalities in lipomas, pulmonary chondroid hamartomas, endometrial polyps, and uterine leiomyomas and is compatible with rearrangement of the HMGI-C and HMGI(Y) genes. Lab Investig J Tech Methods Pathol. 2000;80:359–69.

    Article  CAS  Google Scholar 

  126. Dal Cin P, Timmerman D, Van den Berghe I, Wanschura S, Kazmierczak B, Vergote I, et al. Genomic changes in endometrial polyps associated with tamoxifen show no evidence for its action as an external carcinogen. Cancer Res. 1998;58:2278–81.

    CAS  PubMed  Google Scholar 

  127. Maia H, Pimentel K, Silva TMC, Freitas LAR, Zausner B, Athayde C, et al. Aromatase and cyclooxygenase-2 expression in endometrial polyps during the menstrual cycle. Gynecol Endocrinol. 2006;22:219–24.

    Article  CAS  PubMed  Google Scholar 

  128. Pal L, Niklaus AL, Kim M, Pollack S, Santoro N. Heterogeneity in endometrial expression of aromatase in polyp-bearing uteri. Hum Reprod. 2008;23:80–4.

    Article  CAS  PubMed  Google Scholar 

  129. Zhang C, Sung CJ, Quddus MR, Simon RA, Jazaerly T, Lawrence WD. Association of ovarian hyperthecosis with endometrial polyp, endometrial hyperplasia, and endometrioid adenocarcinoma in postmenopausal women: a clinicopathological study of 238 cases. Hum Pathol. 2017;59:120–4.

    Article  PubMed  Google Scholar 

  130. Berlière M, Radikov G, Galant C, Piette P, Marbaix E, Donnez J. Identification of women at high risk of developing endometrial cancer on tamoxifen. Eur J Cancer. 2000;36(Suppl 4):S35–6.

    Article  PubMed  Google Scholar 

  131. Nappi L, Indraccolo U, Di Spiezio Sardo A, Gentile G, Palombino K, Castaldi MA, et al. Are diabetes, hypertension, and obesity independent risk factors for endometrial polyps? J Minim Invasive Gynecol. 2009;16:157–62.

    Article  PubMed  Google Scholar 

  132. Lee SC, Kaunitz AM, Sanchez-Ramos L, Rhatigan RM. The oncogenic potential of endometrial polyps: a systematic review and meta-analysis. Obstet Gynecol. 2010;116:1197–205.

    Article  PubMed  Google Scholar 

  133. Goldstein SR, Monteagudo A, Popiolek D, Mayberry P, Timor-Tritsch I. Evaluation of endometrial polyps. Am J Obstet Gynecol. 2002;186:669–74.

    Article  PubMed  Google Scholar 

  134. Salim S, Won H, Nesbitt-Hawes E, Campbell N, Abbott J. Diagnosis and management of endometrial polyps: a critical review of the literature. J Minim Invasive Gynecol. 2011;18:569–81.

    Article  CAS  PubMed  Google Scholar 

  135. Savelli L, De Iaco P, Santini D, Rosati F, Ghi T, Pignotti E, et al. Histopathologic features and risk factors for benignity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol. 2003;188:927–31.

    Article  PubMed  Google Scholar 

  136. Li F, Wei S, Yang S, Liu Z, Nan F. Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps. Pak J Med Sci. 2018;34:1267–71.

    PubMed  PubMed Central  Google Scholar 

  137. Arnes M, Hvingel B, Orbo A. Levonorgestrel-impregnated intrauterine device reduces occurrence of hyperplastic polyps: a population-based follow-up cohort study. Anticancer Res. 2014;34:2319–24.

    PubMed  Google Scholar 

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Kossaï, M., Penault-Llorca, F. (2020). Role of Hormones in Common Benign Uterine Lesions: Endometrial Polyps, Leiomyomas, and Adenomyosis. In: Deligdisch-Schor, L., Mareş Miceli, A. (eds) Hormonal Pathology of the Uterus . Advances in Experimental Medicine and Biology, vol 1242. Springer, Cham. https://doi.org/10.1007/978-3-030-38474-6_3

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