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These changes enhance the ability of the endometrium to infiltrate the junctional zone myometrium and the growth of ectopic tissue. In addition, in these subjects several immunological abnormalities have been observed, together with an increased production of \u2018free radicals\u2019 leading to excessive growth of endometrial stromal cells that may facilitate the establishment of adenomyosis. A limiting factor is that these studies have been performed on hysterectomy specimens representing final stages of the disease. This increased knowledge has created new therapeutic options, including the block of local aromatase production through the use of selective estrogen receptor modulators, estrogen-progestin combinations and gonadotropin-releasing hormone super agonists. Also promising are investigations into the mechanism of dysmenorrhea and abnormal uterine bleeding. <\/jats:p>","DOI":"10.2217\/whe.12.8","type":"journal-article","created":{"date-parts":[[2012,5,3]],"date-time":"2012-05-03T13:57:05Z","timestamp":1336053425000},"page":"301-312","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":52,"title":["The Endometrium in Adenomyosis"],"prefix":"10.1177","volume":"8","author":[{"given":"Giuseppe","family":"Benagiano","sequence":"first","affiliation":[{"name":"Department of Gynecology, Obstetrics & Urology Sapienza, University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Brosens","sequence":"additional","affiliation":[{"name":"Leuven Institute for Fertility & Embryology, Leuven, Belgium,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,5,1]]},"reference":[{"key":"bibr1a-WHE.12.8","unstructured":"Papers of special note have been highlighted as:"},{"key":"bibr2a-WHE.12.8","unstructured":"of interest."},{"key":"bibr1-WHE.12.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(99)00263-8"},{"key":"bibr2-WHE.12.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2001.tb03797.x"},{"key":"bibr3-WHE.12.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2011.03.009"},{"key":"bibr4-WHE.12.8","unstructured":"Brosens I, Brosens JJ, Benagiano G. 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