Uterine junctional zone: function and disease

The myometrium is usually thought of as a homogeneous mass of smooth muscle fibres. However, magnetic resonance studies of the uterus have revealed two distinct zones—the subendometrial myometrium or junctional zone and the outer myometrium. The junctional zone is not only structurally but also func...

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Bibliographic Details
Published in:The Lancet (British edition) 1995-08, Vol.346 (8974), p.558-560
Main Authors: Brosens, J.J., de Souza, N.M., Barker, F.G.
Format: Article
Language:English
Subjects:
Architecture
Biological and medical sciences
Bleeding
Endometriosis - pathology
Endometriosis - physiopathology
Endometrium
Endometrium - pathology
Endometrium - physiopathology
Female
Female genital diseases
Gynecology. Andrology. Obstetrics
Humans
Hyperplasia
Infiltration
Magnetic resonance
Magnetic Resonance Imaging
Magnetic studies
Medical disorders
Medical research
Medical sciences
Menstrual Cycle
Mucosa
Muscles
Myometrium
Myometrium - anatomy & histology
Myometrium - pathology
Myometrium - physiology
Non tumoral diseases
Reproductive system
Smooth muscle
Thickening
Uterine Contraction
Uterine Diseases - pathology
Uterine Hemorrhage - pathology
Uterine Hemorrhage - physiopathology
Uterus
Women
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Summary:The myometrium is usually thought of as a homogeneous mass of smooth muscle fibres. However, magnetic resonance studies of the uterus have revealed two distinct zones—the subendometrial myometrium or junctional zone and the outer myometrium. The junctional zone is not only structurally but also functionally different from the outer myometrium. For instance, myometrial contractions in a non-pregnant woman originate exclusively from the junctional zone, and their amplitude, frequency, and direction depend on the phase of the cycle. Irregular thickening of the junctional zone has been proposed as the magnetic resonance criterion for the diagnosis of diffuse adenomyosis. However, this magnetic resonance appearance relies on the disruption of the inner myometrial architecture secondary to smooth muscle hyperplasia but does not provide proof of mucosal invasion of the myometrium. We postulate that adenomyosis is a dichotomous disease characterised primarily by disruption of the inner myometrial architecture and function, with secondary infiltration of endometrial elements into the myometrium under certain circumstances. This hypothesis focuses on the inner myometrium and may explain the high incidence of superficial adenomyosis in dysfunctional uterine bleeding.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(95)91387-4