Endometriosis and ovulatory menstruation: beyond the Sampson principle.

Serdar E Bulun
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Abstract

Endometriosis is an estrogen-dependent chronic inflammatory syndrome characterized by viable endometrial tissue outside the uterine cavity and associated with pain and infertility. Endometriosis, as tissue or a pathological process, is dynamic in that its establishment and progression require repeated episodes of retrograde travel of shed endometrial tissue, which implants in the lower abdominal cavity following ovulatory cycles and survives. Estrogen-rich follicular fluid released onto peritoneal surfaces during ovulation may also support endometriotic implants. DNA evidence indicates that endometriosis originates from eutopic endometrial tissue, which may reach the abdominal cavity in a retrograde manner primarily via the uterine tubes. Unlike uterine bleeding associated with non-ovulatory circumstances, retrograde menstruation following an ovulation maximizes shedding of epithelial cells localized to deep invaginations of the basalis portion of the endometrium, which likely carry somatic cancer-driver mutations such as KRAS. The attached endometrial stromal cells are mostly mutation free but display epigenetic defects including overexpression of aromatase and estrogen receptor-β and downregulation of progesterone receptor, causing estrogen excess and progesterone resistance. These tissue clones may form implants in involuting ovarian corpus luteum cysts and peritoneal surfaces and induce tissue remodeling and fibrosis, manifested as deep-infiltrating endometriosis. The first-line treatment for chronic pelvic pain associated with endometriosis is suppression of ovulation, with the goal of relieving pain. Infertility is often managed using in vitro fertilization, which improves the embryo quality and alters endometrial development.
子宫内膜异位症与排卵月经:超越桑普森原理。
子宫内膜异位症是一种雌激素依赖的慢性炎症综合征,其特征是子宫腔外有活力的子宫内膜组织,并与疼痛和不孕有关。子宫内膜异位症作为一种组织或病理过程是动态的,它的建立和发展需要脱落的子宫内膜组织的反复逆行,这些组织在排卵周期后植入下腹腔并存活。排卵期间释放到腹膜表面的富含雌激素的卵泡液也可能支持子宫内膜异位症植入物。DNA证据表明子宫内膜异位症起源于异位子宫内膜组织,其可能主要通过输卵管逆行到达腹腔。与非排卵期相关的子宫出血不同,排卵期后的月经逆行使位于子宫内膜基底部深层内陷的上皮细胞的脱落最大化,这些细胞可能携带体细胞癌症驱动突变,如KRAS。附着的子宫内膜基质细胞大多无突变,但表现出芳香化酶和雌激素受体-β过表达、孕激素受体下调等表观遗传缺陷,导致雌激素过量和孕激素抵抗。这些组织克隆可在卵巢黄体囊肿和腹膜表面形成植入物,诱导组织重塑和纤维化,表现为深浸润性子宫内膜异位症。慢性盆腔疼痛与子宫内膜异位症相关的一线治疗是抑制排卵,以缓解疼痛为目标。不孕症通常采用体外受精治疗,这可以改善胚胎质量并改变子宫内膜发育。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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