Müllerianosis theory posits that embryonic Müllerian duct remnants misplace and differentiate, forming endometrial-like tissues in non-uterine locations post-puberty, contributing to conditions like endometriosis.
Müllerianosis theory
Researched by:
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Kimberly Eyer
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Kimberly Eyer
Kimberly Eyer, a Registered Nurse with 30 years of nursing experience across diverse settings, including Home Health, ICU, Operating Room Nursing, and Research. Her roles have encompassed Operating Room Nurse, RN First Assistant, and Acting Director of a Same Day Surgery Center. Her specialty areas include Adult Cardiac Surgery, Congenital Cardiac Surgery, Vascular Surgery, and Neurosurgery.
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Kimberly Eyer
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Kimberly Eyer
Müllerianosis theory posits that embryonic Müllerian duct remnants misplace and differentiate, forming endometrial-like tissues in non-uterine locations post-puberty, contributing to conditions like endometriosis.
Research feed -
Karen Pendergrass
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease—four years before the first published case study.
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Kimberly Eyer
Researched by:
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Kimberly Eyer
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Kimberly Eyer
Fact-checked by:
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Kimberly Eyer
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Kimberly Eyer
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Karen Pendergrass
Overview 
Research Feed Overview
Müllerianosis theory explains the development of benign ectopic lesions like endometriosis, adenomyosis, and endosalpingiosis, which involve endometrium-like tissues outside the uterus. Müllerianosis theory suggests that during fetal development, cells from the Müllerian ducts can become displaced or left behind, ending up in various parts of the pelvic and abdominal cavities. The displaced Müllerian tissue remains dormant until puberty, when hormonal changes activate these cells, causing them to proliferate and form lesions typical of conditions like endometriosis. This theory posits that ectopic Müllerian tissues can differentiate into structures resembling parts of the uterus, such as the endometrial glands and stroma (endometriosis), the muscle layer (adenomyosis), or the fallopian tubes (endosalpingiosis). [x] This theory provides a crucial framework for understanding and researching these reproductive conditions, manifesting as misplaced tissues mature in adulthood.
Limitations
While Müllerianosis offers a compelling explanation, it is not without its limitations. There is ongoing debate regarding the precise origins of endometriosis and related conditions. Some researchers argue for alternative theories, such as retrograde menstruation, coelomic metaplasia, and lymphovascular metastasis theory. The Müllerianosis theory does not fully explain why only some develop conditions like endometriosis if all women have Müllerian remnants. This suggests that other factors, like the microbiome, play significant roles.
Research Feed
Müllerian duct anomalies coincident with endometriosis: a review
This study reviewed the relationship between Müllerian duct anomalies (MDAs) and endometriosis, focusing on their prevalence, pathophysiology, and classification. It highlighted the connection especially in cases with outflow obstruction and underscored the need for early diagnosis and targeted interventions to improve reproductive outcomes and manage symptoms.
What was studied?
The study reviewed the relationship between Müllerian duct anomalies (MDAs) and endometriosis, focusing on their coexistence and the underlying pathophysiological theories that might explain their association. It extensively covered the embryology, genetics, and pathophysiology of MDAs, alongside the American Society for Reproductive Medicine (ASRM) classification of these anomalies. The review also detailed different types of MDAs, their diagnosis, and their association with endometriosis, considering various factors such as uterine outflow obstruction and genetic predispositions.
Who was studied?
The study discussed women who present with MDAs and endometriosis, examining available data on the prevalence and nature of these conditions in this demographic. It synthesized information from various studies that stratified the relationship between MDAs and endometriosis according to specific classes of anomalies, particularly focusing on obstructed and non-obstructed MDAs.
What were the most important findings?
Association Between MDAs and Endometriosis: There is an established connection, particularly when the MDA involves outflow obstruction, supporting the theory of retrograde menstruation as a contributing factor to the pathogenesis of endometriosis.
Variability in MDA Prevalence and Impact: The prevalence of MDAs varies widely due to differences in diagnostic techniques and patient populations, with a higher prevalence noted among infertile women and those with recurrent miscarriages.
Complexity of Pathogenesis Theories: The study underscores the complexity of endometriosis pathogenesis, including theories like retrograde menstruation, coelomic metaplasia, and the presence of müllerian remnants, suggesting that different types of endometriosis might arise from different mechanisms.
Genetic Factors: Both conditions are influenced by genetic factors, but no single gene mutation has been directly implicated in causing MDAs or endometriosis, suggesting a multifactorial etiology.
What are the greatest implications of this study?
Improved Diagnostic and Interventional Strategies: Recognizing the association between MDAs and endometriosis, especially in the presence of obstructive anomalies, could lead to earlier diagnosis and more targeted interventions, potentially improving reproductive outcomes and managing pain symptoms effectively.
Need for Further Research: The study highlights the need for more detailed and controlled studies to define the relationship between specific types of MDAs and the various forms of endometriosis. This could help develop more personalized treatment plans and understand the underlying mechanisms at a deeper level.
Clinical Practice Changes: The findings encourage the adoption of standardized classification systems for MDAs and suggest that surgical interventions might be beneficial in cases of obstructed flow to manage or even reverse symptoms of endometriosis, although the outcomes may vary.
Awareness and Screening: There is an emphasis on the importance of awareness and careful screening for endometriosis in patients with MDAs, which could lead to better management strategies and reduce the long-term impact of these conditions on women’s health.
DOI: 10.1007/s00261-020-02465-y
Coincidence of uterine malformations and endometriosis: a clinically relevant problem?
This retrospective study analyzed 279 patients with uterine malformations and found a high prevalence of endometriosis (74.9%), especially among those with non-obstructive malformations. The findings suggest that endometriosis should be proactively investigated in patients with any type of uterine malformation.
What was studied?
The retrospective study explored the prevalence of endometriosis in patients with uterine malformations. It specifically investigated the relationship between different types of uterine malformations (obstructive, non-obstructive, and various classifications under the American Fertility Society (AFS)) and the incidence of endometriosis, which is characterized by the presence of endometrial tissue outside the uterus. The study aimed to determine if obstructive malformations, which could potentially lead to increased retrograde menstruation, have a higher coincidence with endometriosis compared to non-obstructive ones.
Who was studied?
The subjects of the study were patients with uterine malformations who were admitted to the hospital between December 1, 2014, and November 30, 2019. A total of 279 cases were analyzed after excluding certain cases where no laparoscopy was performed. The study group comprised a diverse array of uterine malformations, including non-obstructive malformations, obstructive malformations, and cases of uterine agenesia/hypoplasia.
What were the most important findings?
The study revealed a high prevalence of endometriosis among patients with uterine malformations, particularly in those with obstructive malformations. Key findings include:
| Key Findings | Details |
|---|---|
| Overall Prevalence of Endometriosis | 74.9% of the patients had histologically confirmed endometriosis, which included peritoneal, ovarian, and deep infiltrating endometriosis. |
| Prevalence in Obstructive Uterine Malformations | A particularly high correlation with endometriosis was observed in obstructive uterine malformations, with an incidence of 87.5% in women who had an obstructive malformation with an active endometrium. |
| Prevalence in Septate Uterus | High rates of endometriosis were also found in cases of septate uterus, a common uterine malformation, with an overall prevalence of 77.1%. |
What are the greatest implications of this study?
The findings suggest significant clinical implications for the management of patients with uterine malformations, particularly regarding the diagnosis and treatment of endometriosis. The implications include:
Diagnostic Approach: There should be a high index of suspicion for endometriosis in patients presenting with uterine malformations, especially those with obstructive types. This could lead to more targeted screening and earlier diagnosis.
Integrated Treatment: For patients with both endometriosis and uterine malformations, comprehensive treatment plans that address both conditions simultaneously might improve clinical outcomes.
Fertility Management: Since both endometriosis and uterine malformations can impact fertility, understanding the link between these conditions is crucial for offering appropriate fertility advice and interventions.
Surgical Considerations: The study supports the use of combined diagnostic procedures, such as laparoscopy and hysteroscopy, in the evaluation of such patients to ensure thorough assessment and treatment planning.
Conclusion
Overall, the study underscores the need for specific attention to endometriosis in the presence of uterine malformations to enhance diagnostic accuracy and improve therapeutic strategies, which could ultimately enhance reproductive outcomes and quality of life in affected women.
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.
Retrograde Menstruation Theory
Retrograde menstruation theory holds that during menstruation, some endometrial tissue reverses through the fallopian tubes into the pelvic cavity. It implants on pelvic organs, thickens, breaks down, and bleeds cyclically, causing inflammation, pain, and scar tissue, characteristic of endometriosis.
Coelomic Metaplasia Theory
Coelomic Metaplasia Theory could help explain the cases of endometriosis in men or in women who are not yet menstruating.
Lymphovascular Metastasis Theory
Lymphovascular Metastasis Theory posits that endometrial cells spread via blood and lymph systems, causing distant endometriosis. Evidence is promising but limited.