Why are adenomyosis and endometriosis still such a challenge for women health and reproductive medicine? And how can we better tackle the infertility that so often accompanies them? These were the key questions debated by clinicians and scientists across Europe and beyond at an intensive two-day Campus in Milan.
The meeting opened with a thought-provoking keynote lecture from Dr. Vercellini, who reframed endometriosis and adenomyosis through an evolutionary lens. He described them as “diseases of evolutionary mismatch”, the by-product of rapid societal and reproductive transitions. Modern women experience far more menstrual cycles and ovulations (and, with them, chronic menstrual inflammation) than previous generations did(1). The message was clear: biology has not yet caught up with evolutionary changes.
From this broad perspective, the course moved into the epidemiology and risk factors. Dr. Kvaskoff explored the many aspects of diagnostic delay and exposure risks, while Dr. Burns took a deep dive into environmental science, from pollution to endocrine disruptors, presenting mouse models that support a two-step model of endometriosis development: an immune-dependent phase followed by a hormone-dependent progression. The clinical focus was provided by Dr. Vanhie, who illustrated how advances in imaging are reshaping the diagnostic landscape, helping clinicians to characterise and stratify disease phenotypes more effectively before fertility treatment.
On the mechanistic perspective, Dr. Casalechi delivered a “masterclass in 30 minutes”, talking the audience through the complex biological and molecular pathways linking endometriosis and adenomyosis to infertility. Dr. Hapangama then broadened the scope by presenting novel data on spatial molecular profiling of the endometrium.
Day two opened with a provocative question: is the problem the “egg” or the “nest”? Dr. Sunkara discussed the often-overlooked aspects of oocyte and embryo quality, while Dr. Mijatovic redirected the spotlight to the uterus, a neglected player that he said deserved a campus course of its own.
Management strategies, both surgical and medical, were the focus of the later sessions. Drs. Nap, Bafort and Mabrouk revisited long-standing debates on whether, and how, to treat peritoneal endometriosis, endometriomas and deep lesions, respectively. On the same topic, the poster award went to Dr. Benaglia for the SVIDOE randomised trial, showing a clear advantage of IVF over surgery for ovarian and deep endometriosis regarding pregnancy outcomes, a finding that sparked lively discussion.
Dr. Santulli presented evidence on adenomyosis management, highlighting diagnostic uncertainty and therapeutic heterogeneity, and calling for a redefinition of treatment strategies (2). Finally, Dr. Somigliana brought the meeting to a close with a forward-looking lecture, challenging the audience to “rethink staging, infertility, and ART” in endometriosis (3). He suggested using “adenometriosis” as a unifying term that bridges the two diseases.
In the end, the Milan Campus was more than a scientific meeting. It was also a reminder that adenomyosis and endometriosis sit at the crossroads of evolution, environment, and clinical care. Understanding their shared biology may be the key to unlocking better fertility outcomes for women worldwide.
References
1. Vercellini P, Bandini V, Viganò P, Di Stefano G, Merli CEM, Somigliana E. Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects. Hum Reprod. 2024 Jan 5;39(1):1-17.
2. Bourdon M, Santulli P, Bordonne C, Millisher AE, Maitrot-Mantelet L, Maignien C, Marcellin L, Melka L, Chapron C. Presence of adenomyosis at MRI reduces live birth rates in ART cycles for endometriosis. Hum Reprod. 2022 Jun 30;37(7):1470-1479.
3. Somigliana E, Li Piani L, Paffoni A, Salmeri N, Orsi M, Benaglia L, Vercellini P, Vigano’ P. Endometriosis and IVF treatment outcomes: unpacking the process. Reprod Biol Endocrinol. 2023 Nov 7;21(1):107.
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