Skip to main content

The Myometrium in Heath and Disease

  • Chapter
  • First Online:
Uterine Adenomyosis

Abstract

The uterus consists of two major tissue components; the muscular layer (the myometrium) and the inner mucosal lining (the endometrium). Cyclical endometrial changes and its functional role in relation to implantation and subsequent embryo and fetal development have been the focus of research for many decades. Recent evidence suggests that the myometrium has an important supportive role during early pregnancy and that it acquires more significance as the uterus adapts to the growing fetus and in parturition. Postnatally, the myometrium has a role in preventing excessive blood loss. Dysregulation of myometrial function is associated with adverse outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Noyes RW, Hertig AT, Rock J. Dating the endometrofial biopsy. Am J Obstet Gynecol. 1975;122(2):262–3.

    Article  CAS  PubMed  Google Scholar 

  2. Mertens HJ, Heineman MJ, Theunissen PH, de Jong FH, Evers JL. Androgen, estrogen and progesterone receptor expression in the human uterus during the menstrual cycle. Eur J Obstet Gynecol Reprod Biol. 2001;98:58–65.

    Article  CAS  PubMed  Google Scholar 

  3. Nantermet PV, Masarachia P, Gentile MA, Pennypacker B, Xu J, Holder D, et al. Androgenic induction of growth and differentiation in the rodent uterus involves the modulation of estrogen-regulated genetic pathways. Endocrinology. 2005;146(2):564–78.

    Article  CAS  PubMed  Google Scholar 

  4. Li H, Li Y, Morin D, Plymate S, Lye SJ, Dong X. The androgen receptor mediates antiapoptotic function in myometrial cells. Cell Death Dis. 2014;5, e1338.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Makieva S, Saunders PT, Norman JE. Androgens in pregnancy: roles in parturition. Hum Reprod Update. 2014;20(4):542–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Brosens JJ, de Souza NM, Barker FG. Uterine junctional zone: function and disease. Lancet. 1995;346(8974):558–60.

    Article  CAS  PubMed  Google Scholar 

  7. Naftolin J, Jurkovic D. The endometrial-myometrial junction: a fresh look at a busy crossing. Ultrasound Obstetr Gynecol. 2009;34:1–11.

    Article  Google Scholar 

  8. Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. Uterine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed Online. 2008;17(2):244–8.

    Article  PubMed  Google Scholar 

  9. Kunz G, Beil D, Huppert P, Leyendecker G. Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging. Hum Reprod. 2000;15(1):76–82.

    Article  CAS  PubMed  Google Scholar 

  10. Devedeux D, Marque C, Mansour S, Germain G, Duchene J. Uterine electromyography: a critical review. Am J Obstet Gynecol. 1993;169(6):1636–53.

    Article  CAS  PubMed  Google Scholar 

  11. Ono M, Maruyama T, Masuda H, Kajitani T, Nagashima T, Arase T, et al. Side population in human uterine myometrium displays phenotypic and functional characteristics of myometrial stem cells. Proc Natl Acad Sci U S A. 2007;104(47):18700–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Holdsworth-Carson SJ, Zaitseva M, Vollenhoven BJ, Rogers PA. Clonality of smooth muscle and fibroblast cell populations isolated from human fibroid and myometrial tissues. Mol Hum Reprod. 2014;20(3):250–9.

    Article  CAS  PubMed  Google Scholar 

  13. Noe M, Kunz G, Herbertz M, Mall G, Leyendecker G. The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: characterization of the endometrial-subendometrial unit. Hum Reprod. 1999;14(1):190–7.

    Article  CAS  PubMed  Google Scholar 

  14. Mehasseb MK, Bell SC, Brown L, Pringle JH, Habiba MA. Phenotypic characterisation of the inner and outer myometrium in adenomyotic uteri. Gynecol Obstet Invest. 2011;71:217–24.

    Article  PubMed  Google Scholar 

  15. de Vries K, Lyons EA, Ballard G, Levi CS, Lindsay DJ. Contractions of the inner third of the myometrium. Am J Obstet Gynecol. 1990;162(3):679–82.

    Article  PubMed  Google Scholar 

  16. Ijland MM, Evers JL, Dunselman GA, van Katwijk C, Lo CR, Hoogland HJ. Endometrial wavelike movements during the menstrual cycle. Fertil Steril. 1996;65(4):746–9.

    Article  CAS  PubMed  Google Scholar 

  17. Ikeda M, Shibata Y, Yamamoto T. Rapid formation of myometrial gap junctions during parturition in the unilaterally implanted rat uterus. Cell Tissue Res. 1987;248(2):297–303.

    Article  CAS  PubMed  Google Scholar 

  18. Kunz G, Beil D, Deininger H, Wildt L, Leyendecker G. The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy. Hum Reprod. 1996;11(3):627–32.

    Article  CAS  PubMed  Google Scholar 

  19. Banerjee M, Chowdhury M. Purification and characterization of a sperm-binding glycoprotein from human endometrium. Hum Reprod. 1994;9(8):1497–504.

    Article  CAS  PubMed  Google Scholar 

  20. Hunter RH, Cook B, Poyser NL. Regulation of oviduct function in pigs by local transfer of ovarian steroids and prostaglandins: a mechanism to influence sperm transport. Eur J Obstet Gynecol Reprod Biol. 1983;14(4):225–32.

    Article  CAS  PubMed  Google Scholar 

  21. Gebeh AK, Willets JM, Marczylo EL, Taylor AH, Konje JC. Ectopic pregnancy is associated with high anandamide levels and aberrant expression of FAAH and CB1 in fallopian tubes. J Clin Endocrinol Metab. 2012;97(8):2827–35.

    Article  CAS  PubMed  Google Scholar 

  22. van der Linden PJ. Theories on the pathogenesis of endometriosis. Hum Reprod. 1996;11 Suppl 3:53–65.

    Article  PubMed  Google Scholar 

  23. Kirby DR, Potts DM, Wilson IB. On the orientation of the implanting blastocyst. J Embryol Exp Morphol. 1967;17(3):527–32.

    CAS  PubMed  Google Scholar 

  24. Maccarrone M, De Felici M, Bari M, Klinger F, Siracusa G, Finazzi-Agro A. Down-regulation of anandamide hydrolase in mouse uterus by sex hormones. Eur J Biochem FEBS. 2000;267(10):2991–7.

    Article  CAS  Google Scholar 

  25. Schmid PC, Paria BC, Krebsbach RJ, Schmid HH, Dey SK. Changes in anandamide levels in mouse uterus are associated with uterine receptivity for embryo implantation. Proc Natl Acad Sci U S A. 1997;94(8):4188–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Brighton PJ, McDonald J, Taylor AH, Challiss RA, Lambert DG, Konje JC, et al. Characterization of anandamide-stimulated cannabinoid receptor signaling in human ULTR myometrial smooth muscle cells. Mol Endocrinol. 2009;23(9):1415–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Fonseca BM, Correia-da-Silva G, Taylor AH, Konje JC, Bell SC, Teixeira NA. Spatio-temporal expression patterns of anandamide-binding receptors in rat implantation sites: evidence for a role of the endocannabinoid system during the period of placental development. Reprod Biol Endocrinol RB&E. 2009;7:121.

    Article  Google Scholar 

  28. Melford SE, Taylor AH, Konje JC. Of mice and (wo)men: factors influencing successful implantation including endocannabinoids. Hum Reprod Update. 2014;20(3):415–28.

    Article  PubMed  Google Scholar 

  29. Jofre NM, Delpiano AM, Cuello MA, Poblete JA, Vargas PA, Carvajal JA. Isoform alpha of PKC may contribute to the maintenance of pregnancy myometrial quiescence in humans. Reprod Sci. 2013;20(1):69–77.

    Article  CAS  PubMed  Google Scholar 

  30. Mesiano S, Chan EC, Fitter JT, Kwek K, Yeo G, Smith R. Progesterone withdrawal and estrogen activation in human parturition are coordinated by progesterone receptor A expression in the myometrium. J Clin Endocrinol Metab. 2002;87(6):2924–30.

    Article  CAS  PubMed  Google Scholar 

  31. Brosens JJ, Hayashi N, White JO. Progesterone receptor regulates decidual prolactin expression in differentiating human endometrial stromal cells. Endocrinology. 1999;140(10):4809–20.

    Article  CAS  PubMed  Google Scholar 

  32. Tan H, Yi L, Rote NS, Hurd WW, Mesiano S. Progesterone receptor-A and -B have opposite effects on proinflammatory gene expression in human myometrial cells: implications for progesterone actions in human pregnancy and parturition. J Clin Endocrinol Metab. 2012;97(5):E719–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Mitsuya K, Singh N, Sooranna SR, Johnson MR, Myatt L. Epigenetics of human myometrium: DNA methylation of genes encoding contraction-associated proteins in term and preterm labor. Biol Reprod. 2014;90(5):98.

    Article  PubMed  Google Scholar 

  34. Korita D, Sagawa N, Itoh H, Yura S, Yoshida M, Kakui K, et al. Cyclic mechanical stretch augments prostacyclin production in cultured human uterine myometrial cells from pregnant women: possible involvement of up-regulation of prostacyclin synthase expression. J Clin Endocrinol Metab. 2002;87(11):5209–19.

    Article  CAS  PubMed  Google Scholar 

  35. Loudon JA, Sooranna SR, Bennett PR, Johnson MR. Mechanical stretch of human uterine smooth muscle cells increases IL-8 mRNA expression and peptide synthesis. Mol Hum Reprod. 2004;10(12):895–9.

    Article  CAS  PubMed  Google Scholar 

  36. Lyall F, Lye S, Teoh T, Cousins F, Milligan G, Robson S. Expression of Gsalpha, connexin-43, connexin-26, and EP1, 3, and 4 receptors in myometrium of prelabor singleton versus multiple gestations and the effects of mechanical stretch and steroids on Gsalpha. J Soc Gynecol Investig. 2002;9(5):299–307.

    Article  CAS  PubMed  Google Scholar 

  37. Sooranna SR, Lee Y, Kim LU, Mohan AR, Bennett PR, Johnson MR. Mechanical stretch activates type 2 cyclooxygenase via activator protein-1 transcription factor in human myometrial cells. Mol Hum Reprod. 2004;10(2):109–13.

    Article  CAS  PubMed  Google Scholar 

  38. Shinlova OP, Oldenhof AD, Liu M, Langille L, Lye SJ. Regulation of c-fos expression by static stretch in rat myometrial smooth muscle cells. Am J Obstet Gynecol. 2002;186(6):1358–65.

    Article  Google Scholar 

  39. Terzidou V, Sooranna SR, Kim LU, Thornton S, Bennett PR, Johnson MR. Mechanical stretch up-regulates the human oxytocin receptor in primary human uterine myocytes. J Clin Endocrinol Metab. 2005;90(1):237–46.

    Article  CAS  PubMed  Google Scholar 

  40. Shynlova O, Nedd-Roderique T, Li Y, Dorogin A, Lye SJ. Myometrial immune cells contribute to term parturition, preterm labour and post-partum involution in mice. J Cell Mol Med. 2013;17(1):90–102.

    Article  CAS  PubMed  Google Scholar 

  41. Skurupiy VA, Obedinskaya KS, Nadeev AP. Structural manifestations of mechanisms of myometrium involution after repeated pregnancies in mice. Bull Exp Biol Med. 2010;149(5):554–8.

    Article  CAS  PubMed  Google Scholar 

  42. Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):547–55.

    Article  CAS  PubMed  Google Scholar 

  43. Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001;16(11):2418–21.

    Article  CAS  PubMed  Google Scholar 

  44. Lertvikool S, Sukprasert M, Pansrikaew P, Rattanasiri S, Weerakiet S. Comparative study of nerve fiber density between adenomyosis patients with moderate to severe pain and mild pain. J Med Assoc Thailand = Chotmaihet thangphaet. 2014;97(8):791–7.

    Google Scholar 

  45. Huang Y, Zheng W, Mu L, Ren Y, Chen X, Liu F. Expression of tyrosine kinase receptor B in eutopic endometrium of women with adenomyosis. Arch Gynecol Obstet. 2011;283(4):775–80.

    Article  CAS  PubMed  Google Scholar 

  46. Taylor AH, Hawes MP, Kalathy V, Abbas MA, Mehasseb MK, Habiba MA. Differential regulation of the neurotrophins, NGF and BDNF, and their receptors in the myometrium of women affected by adenomyosis. Endocr Abstr. 2011;25:P117.

    Google Scholar 

  47. Greaves P, White IN. Experimental adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):503–10.

    Article  PubMed  Google Scholar 

  48. Zhang X, Lu B, Huang X, Xu H, Zhou C, Lin J. Innervation of endometrium and myometrium in women with painful adenomyosis and uterine fibroids. Fertil Steril. 2010;94(2):730–7.

    Article  PubMed  Google Scholar 

  49. Kanda N, Watanabe S. 17Beta-estradiol enhances the production of nerve growth factor in THP-1-derived macrophages or peripheral blood monocyte-derived macrophages. J Invest Dermatol. 2003;121(4):771–80.

    Article  CAS  PubMed  Google Scholar 

  50. Kissler S, Zangos S, Wiegratz I, Kohl J, Rody A, Gaetje R, et al. Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis. Ann New York Acad Sci. 2007;1101:38–48.

    Article  Google Scholar 

  51. Ijland MM, Evers JL, Dunselman GA, Volovics L, Hoogland HJ. Relation between endometrial wavelike activity and fecundability in spontaneous cycles. Fertil Steril. 1997;67(3):492–6.

    Article  CAS  PubMed  Google Scholar 

  52. Martinez-Conejero JA, Morgan M, Montesinos M, Fortuno S, Meseguer M, Simon C, et al. Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation. Fertil Steril. 2011;96(4):943–50.

    Article  PubMed  Google Scholar 

  53. Salim R, Riris S, Saab W, Abramov B, Khadum I, Serhal P. Adenomyosis reduces pregnancy rates in infertile women undergoing IVF. Reprod Biomed Online. 2012;25(3):273–7.

    Article  PubMed  Google Scholar 

  54. Juang CM, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL. Adenomyosis and risk of preterm delivery. Br J Obstet Gynaecol. 2007;114(2):165–9.

    Google Scholar 

  55. Enakpene CA, Meneyyiri-Debale O. Association between etiopathogenesis of morbidly adherent placenta and adenomyosis. Open J Obstet Gynecol. 2012;2:321–4.

    Article  Google Scholar 

  56. Pafumi C, Farina M, Pericone G, Russo A, Bandiera S, Giardina P, et al. Adenomyosis and uterus rupture during labor. Zhonghua Yi Xue Za Zhi (Taipei). 2001;64(4):244–6.

    CAS  Google Scholar 

  57. Maheshwari A, Gurunath S, Fatima F, Bhattacharya S. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18(4):374–92.

    Article  PubMed  Google Scholar 

  58. Parrott E, Butterworth M, Green A, White IN, Greaves P. Adenomyosis – a result of disordered stromal differentiation. Am J Pathol. 2001;159(2):623–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Bulletti C, de Ziegler D. Uterine contractility and embryo implantation. Curr Opin Obstet Gynecol. 2006;18(4):473–84.

    Article  PubMed  Google Scholar 

  60. Ota H, Igarashi S, Hatazawa J, Tanaka T. Is adenomyosis an immune disease? Hum Reprod Update. 1998;4(4):360–7.

    Article  CAS  PubMed  Google Scholar 

  61. Taran FA, Wallwiener M, Kabashi D, Rothmund R, Rall K, Kraemer B, et al. Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet. 2012;285(6):1571–6.

    Article  PubMed  Google Scholar 

  62. Karakok M, Balat O, Sari I, Kocer NE, Erdogan R. Early diagnosed intramural ectopic pregnancy associated with adenomyosis: report of an unusual case. Clin Exp Obstet Gynecol. 2002;29(3):217–8.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anthony H. Taylor PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Taylor, A.H., Habiba, M. (2016). The Myometrium in Heath and Disease. In: Habiba, M., Benagiano, G. (eds) Uterine Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13012-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13012-5_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13011-8

  • Online ISBN: 978-3-319-13012-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics