European journal of obstetrics & gynecology and reproductive biology: X · 2026
A hypothesis on the aetiology of adenomyosis: is there an association between cumulative number of menstruations and severity of adenomyosis on ultrasound?
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
de Bock Eva J E, Verbeek Cilla, Klinkenberg Eva, Twisk Jos W R, Burger Nicole B, Juffermans Lynda J M, Huirne Judith A F, de Leeuw Robert A
Аннотация
RATIONALE: Adenomyosis is a common uterine disorder, yet its aetiology remains debated. The tissue injury and repair (TIAR) hypothesis suggests that repeated microtrauma from menstrual contractions damages the endometrial-myometrial interface, thereby contributing to development and progression of adenomyosis. We investigated whether cumulative menstrual exposure is associated with severity of adenomyosis on ultrasound.
METHODS: This exploratory retrospective study was conducted at Amsterdam University Medical Centre, as a sub-analysis of the prospective UteroVue cohort study. For the UteroVue study, premenopausal participants with and without adenomyosis were recruited via the benign gynaecology outpatient clinic and through flyering, and underwent transvaginal ultrasound. The percentage of myometrium affected by Morphological Uterus Sonographic Assessment features of adenomyosis was estimated. For this sub-analysis, cumulative menstrual exposure was derived from menstrual history questionnaires, accounting for pregnancy, lactation, and hormonal menstruation suppression. The association between cumulative menstruations and disease severity was assessed using multivariable regression analyses with collinearity evaluation.
RESULTS: We included 119 participants in the final analysis. The median age of the study population was 27 years, of whom 79% were nulliparous and 14% had a history of uterine surgery. Previous hormonal menstruation suppression with the oral contraceptive pill was reported by 87% of participants, with a median duration of use of 7 years. In addition, 32% had previously used a hormonal intrauterine device, with a median duration of use of 3 years. Age was excluded from multivariable analyses due to collinearity (r = 0.72). After adjustment for vaginal births and uterine surgeries, cumulative menstrual exposure was associated with severity of adenomyosis (β=0.003; 95% CI 1.001-1.006; p < 0.05).
CONCLUSION: Higher cumulative menstrual exposure was associated with increased severity of adenomyosis, supporting the TIAR hypothesis. Given the retrospective study design and collinearity with age, results should be interpreted with caution.
METHODS: This exploratory retrospective study was conducted at Amsterdam University Medical Centre, as a sub-analysis of the prospective UteroVue cohort study. For the UteroVue study, premenopausal participants with and without adenomyosis were recruited via the benign gynaecology outpatient clinic and through flyering, and underwent transvaginal ultrasound. The percentage of myometrium affected by Morphological Uterus Sonographic Assessment features of adenomyosis was estimated. For this sub-analysis, cumulative menstrual exposure was derived from menstrual history questionnaires, accounting for pregnancy, lactation, and hormonal menstruation suppression. The association between cumulative menstruations and disease severity was assessed using multivariable regression analyses with collinearity evaluation.
RESULTS: We included 119 participants in the final analysis. The median age of the study population was 27 years, of whom 79% were nulliparous and 14% had a history of uterine surgery. Previous hormonal menstruation suppression with the oral contraceptive pill was reported by 87% of participants, with a median duration of use of 7 years. In addition, 32% had previously used a hormonal intrauterine device, with a median duration of use of 3 years. Age was excluded from multivariable analyses due to collinearity (r = 0.72). After adjustment for vaginal births and uterine surgeries, cumulative menstrual exposure was associated with severity of adenomyosis (β=0.003; 95% CI 1.001-1.006; p < 0.05).
CONCLUSION: Higher cumulative menstrual exposure was associated with increased severity of adenomyosis, supporting the TIAR hypothesis. Given the retrospective study design and collinearity with age, results should be interpreted with caution.