A role of the uterine cervix in the pathogenesis of adenomyosis and endometriosis?

Abstract

Data indicate a link between the cervix and pathologies like adenomyosis and endometriosis. Uterine flexion on the cervix, diameter and stiffness of the internal cervical orifice represent an obstacle to downstream menstrual flow, that when excessive increases the intensity of uterine contractions. Evidence indicates that intense uterine contractions damage the endometrial myometrial junction, favoring endometrial entrance into the myometrium, to induce adenomyosis, and retrograde menstrual flow into the peritoneal cavity, to induce endometriosis. As a consequence of local hyperestrogenism in women with adenomyosis the cervical mucus barrier is reduced. Because of an increased prevalence of non-lactobacilli dominated vagino-types, the ascent of vaginal pathogens is also increased. Richness of endometrial and pelvic microbiota, lead to a higher rate of endometritis, and subclinical chronic pelvic infections in women with adenomyosis and concomitant endometriosis, respectively. Studies targeting the cervix as an actor on the pathogenesis of adenomyosis and endometriosis are warranted.

Keywords: adenomyosis; cervix; dysmenorrhea; endometriosis; endometritis; infertility; pelvic inflammatory disease.