Research recommendations
Future studies are warranted to delineate the pathophysiology by which pain is induced in adenomyosis lesion during pregnancy. Confirming the histologic features of adenomyosis lesion during pregnancy may aid in elucidating the underlying pathophysiology, although the pathology of the uterus and the adenomyosis lesion during pregnancy is difficult to determine owing to the nature of the disease. Considering the difficulty of obtaining diagnostic confirmation based on histologic features, confirmation of the adenomyosis lesion with serial MRIs before conception and during adenomyosis pain, as shown previously, (11) (24) may aid in delineating the pathophysiology of the adenomyosis pain during pregnancy; therefore, more reports based on serial MRI findings are awaited. After accumulation of these data, it may be possible to unravel the characteristic findings of adenomyosis which lead to adenomyosis pain during pregnancy.
Future research should aim to elucidate the pain mechanism in adenomyosis as associated with the onset of PE. PE is a multifactorial disease, and one of the known pathophysiology that may trigger the onset of PE is enhanced inflammation.(33, 34) However, the precise mechanism by which the inflammation induces PE is yet to be elucidated. Moreover, the type of adenomyosis or the maternal background associated with the onset of the adenomyosis pain during pregnancy and subsequent PE cannot be concluded from our small sample size; therefore, more reports on this phenomenon are warranted for further evaluation. Elucidating the mechanism by which PE is induced from adenomyosis pain may in turn unravel one aspect of the pathophysiology of PE.