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In adenomyosis, the two major frequent symptoms are hypermenorrhea and dysmenorrhea. The incidence of the former is said to be high, ranging from 36 to 70%. It has been found that vascular distribution of the endometrium in adenomyosis is diversely different from fertile patients without adenomyosis. For example, hysteroscopy revealed that approximately half of the patients have abnormal vascularization. In these patients, vascular distribution was generally irregular, and vessels were thick, dilated, and/or reticular in some patients. Moreover, morphometric analysis of the endometrium revealed that in the fertile women, the mean surface area, total surface area, and total number of capillaries, all increased significantly in the secretory phase compared to the proliferative phase. In contrast, the above parameters increased in the adenomyosis group in both the proliferative phase and secretory phase compared to the fertile women. In particular, the total surface area of capillaries per mm(2) markedly rose, by 11.6 times, compared to that of the proliferative phase in the fertile women. These findings suggest that regulatory factors involved in the vascular proliferation are diversely exaggerated, and that the abnormal vascularization of the endometrium is closely related with hypermenorrhea., (Copyright 2003 Wiley-Liss, Inc.)

Objective: To determine the distribution of catalase in eutopic and ectopic endometria in patients with endometriosis or adenomyosis., Design: Retrospective randomized study., Setting: Department of obstetrics and gynecology in a university hospital., Patient(s): Thirty-three patients with endometriosis, 36 with adenomyosis, and 47 fertile controls (total, 116 women)., Main Outcome Measure(s): Semiquantitative immunostaining of endometrial cells obtained by biopsy sampling, followed by calculation of an evaluation nomogram score., Result(s): The score of catalase in the glandular epithelium of controls group fluctuated during the menstrual cycle; it was lowest in the early proliferative phase and peaked in the late secretory phase. In patients with endometriosis, catalase scores did not fluctuate during the cycle, and scores were high compared with controls throughout the menstrual cycle. Catalase scores did not vary in patients with adenomyosis, and scores in this group were consistently higher than those in patients with endometriosis throughout the cycle., Conclusion(s): Abnormal expression of catalase in the eutopic and ectopic endometrium strongly suggests pathologic involvement of free radicals in endometriosis and adenomyosis.

Background: One immune characteristic of endometriosis is a decrease in natural killer (NK) cell activity. This study was performed to determine whether an abnormal immune reaction in an endometriosis animal model could be transferred to an animal of the same species., Methods: An endometriosis model was prepared using 8 week old female rats by grafting a small section of one uterine horn onto the mesentery, followed 4 weeks later by removal of the spleen and remaining uterine horn. Splenocytes, that had been depleted of macrophages were injected via the tail vein, and NK cell activity of splenocytes was determined 4 days later. The uterus was simultaneously investigated immunohistochemically for immune cells. There was a control group (untreated; group 1), a control-splenocyte injection group (group 2), an experimental endometriosis model group (group 3) and an endometriosis model splenocyte injection group (group 4)., Results: Splenocyte NK cell activity was decreased in group 3 to 42.0% of that of group 1 and in group 4 to 38.9%. Immunohistologically, the number of NK cells in groups 3 and 4 markedly decreased to 62.0 and 55.1% of group 1 respectively., Conclusion: It was demonstrated that abnormal immunity caused by allograft of immune cells could recur in an endometriosis rat model.

Three women with adenomyosis conceived by in vitro fertilization–embryo transfer (IVF–ET), but miscarried in the second trimester. The uterus in each case was inflamed post-partum and one patient underwent total abdominal hysterectomy as treatment for the severe inflammation. Although the mechanism of the miscarriages is unclear, these cases strongly suggest that it is related to the inflammation of the myometrium associated with adenomyosis, and that such pregnancies have a high risk of not continuing to term. Preventing inflammation could result in a live birth. (Reprod Med Biol 2004; 3: 95–98) [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the distribution of cyclooxygenase-2 (COX-2) in eutopic and ectopic endometria in endometriosis and adenomyosis. The subjects were 35 patients with endometriosis diagnosed by laparoscopy, 33 patients with histologically confirmed adenomyosis and 50 female controls with normal fecundity. Expression of COX-2 was immunohistochemically investigated in tissues from eutopic endometrium and myometrium and ectopic endometrium of the wall of ovarian chocolate cysts using polyclonal antibody. Surface epithelial cells, endometrial glandular epithelial cells or stromal cells were assessed. Cells were semi-quantitatively assessed on a scale of 1 to 5 using a nomogram created from positive cell count and the degree of staining. COX-2 expression in surface and glandular epithelia of the control group varied markedly during the menstrual cycle. It was lowest in the early proliferative phase and gradually increased thereafter. It remained high throughout the secretory phase. However, in patients with endometriosis, expression of COX-2 in glandular epithelium was higher than that in the control group, though it varied throughout the menstrual cycle. On the other hand, there was no variation in expression of COX-2 in the adenomyosis group during the menstrual cycle, and it was lower than that in the endometriosis group in all phases. Pronounced COX-2 expression was observed in glandular cells from ectopic endometrial tissue of ovarian chocolate cyst walls in all cases regardless of the menstrual phase. In summary, increased COX-2 expression in eutopic and ectopic endometria was believed to be strongly correlated with pathological abnormalities in these disorders. [ABSTRACT FROM PUBLISHER]

The effect of peritoneal fluid (PF) from endometriosis patients was studied in spontaneous and stimulus-induced (Ca-ionophore; A23187) acrosome reactions. PF samples were obtained from 21 infertile women with endometriosis and five normal women (controls). Sperm acrosomes were examined by staining with agglutinin labelled with fluorescein isothiocyanate. The incidence of spontaneous acrosome reaction after 1 and 6 h of incubation (6.7 ± 1.6 and 6.9 ± 1.4 respectively) was significantly ( < 0.001) lower when the incubation was performed with PF from endometriosis patients in comparison with spermatozoa incubated in PF from the control group (12.8 ± 1.1 and 12.8 ± 0.8). Similarly, the incidence of A23187-induced acrosome reaction after 1 and 6 h of incubation (19.8 ± 2.7 and 20.0 ± 2.4) was significantly ( < 0.001) lower when spermatozoa were incubated with PF from endometriosis patients in comparison with spermatozoa incubated with PF from the control group (34.6 ± 9.8 and 34.4 ± 1.1). The incidence of A23187-inducible acrosome reaction was also significantly ( < 0.001) lower when the incubation was performed with PF from endometriosis patients (13.1 ± 2.8 and 13.1 ± 2.4) when compared with that from the control group (21.8 ± 2.6 and 21.6 ± 1.5). No relationship was found between the stage of endometriosis and the incidence of acrosome loss. In conclusion, the PF from endometriosis patients decreased both spontaneous and stimulus-induced acrosome reaction. This may represent a mechanism for the detrimental effect of the PF from endometriosis patients on the spermatozoa-oocyte interaction and partially explain the aetiology of infertility in patients with endometriosis. [ABSTRACT FROM PUBLISHER]