Dysmenorrhea in patients with adenomyosis: A clinical and demographic study - 14/02/21

Doi : 10.1016/j.jogoh.2020.101761

Qing Li ^a, Jian Huang ^a, Xu-Yin Zhang ^a, Wei-Wei Feng ^c, Ke-Qin Hua ^a,^b,^⁎
^a Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, China
^b Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China
^c Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China

^⁎Corresponding author at: Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai, China.Shanghai Key Laboratory of Female Reproductive Endocrine-Related DiseaseFudan UniversityShanghaiChina

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Abstract

Objective

To identify the risk factors associated with dysmenorrhea in adenomyosis and to discuss the potential hormone-based understanding of pain mechanisms.

Study design

Adenomyosis patients with mild or no dysmenorrhea (n = 40, Group 1) and moderate-to-severe dysmenorrhea (n = 80, Group 2) were recruited. Charts of all patients were recorded. An immunohistochemistry (IHC) analysis was performed to detect the cellular levels of estrogen receptor-α (ER-α), estrogen receptor-β (ER-β), gonadotropin-releasing hormone receptor (GnRH-R), and neurofilaments (NFs) in 60 cases.

Results

A history of cesarean section (CS) was positively related to the degree of dysmenorrhea in adenomyosis (OR (95 % CI): 4.397 (1.371–14.104)). The ER-α levels in the eutopic endometrium (EUE) of Group 2 were higher than those in the ectopic endometrium (ECE) of Group 1. Group 2 had higher NF levels in the ECE than in the EUE.

Conclusion

A history of CS is a risk factor for adenomyosis with moderate-to-severe dysmenorrhea. For patients with adenomyosis, high ER-α levels in the EUE and high NF levels in the ECE may be related to moderate-to-severe dysmenorrhea. These hormone-based mechanisms may contribute to our understanding of the pathogenesis of dysmenorrhea in adenomyosis.

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Keywords : Adenomyosis, Dysmenorrhea, Cesarean section, Estrogen receptor-α (ER-α), Estrogen receptor-β (ER-β), Gonadotropin-releasing hormone receptor (GnRH-R), Neurofilaments (NFs)