Uterine disorders in reproductive life

Abstract

The development of new medical diagnostic technologies and procedures and the drop in the birth rate observed in the last decades represent the main causes of increased incidence of uterine disorders. Endometriosis, adenomyosis and uterine fibroids are benign uterine disorders whose understanding have greatly increased and clinical management have improved in recent times. Molecular pathogenetic aspects, new imaging technologies (transvaginal ultrasound and magnetic resonance), biochemical markers, hormonal drugs, minimally invasive surgical technologies were studied for diagnosis and treatment of endometriosis, adenomyosis and uterine fibroids. Sex steroid hormones, inflammation and fibrosis are key pathogenetic mechanisms of uterine disorders. Endometriosis is characterized by endometrial cells migrating outside the uterus and implanting in the pelvis, associated with inflammation, neuroangiogenesis and fibrosis causing dysmenorrhea, pelvic pain, dysuria and dyschezia. The painful symptoms may activate central sensitization and stress responses. Adenomyosis is caused by the presence of endometrial cells within the myometrium, characterized by pelvic pain, abundant menstrual bleeding and infertility. Heavy menstrual bleeding can cause the reduction of iron reserves and consequently iron deficiency anemia. Uterine fibroids are the most common benign tumors of the uterus in women of reproductive age. They can be asymptomatic, but they frequently manifest with abnormal uterine bleeding, pelvic discomfort, and challenges with fertility. Submucosal or intramural fibroids can hinder embryo implantation and potentially lead to pregnancy-related complications such as miscarriage, placenta previa, preterm labor, or postpartum hemorrhage. The increased incidence of uterine disorders has a major clinical impact on women’s health and a very poor quality of life is often reported. Therefore, prompt diagnosis and effective management are mandatory.