Quote · The Peter Attia Drive
#397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.
Where this was said
Adenomyosis explained: how it differs from endometriosis, why it develops, and its impact on reproductive health
At 15:35 · chapter starts 13:25
Tomioka opens this section with a claim that reframes the conversation: adenomyosis is 'the missed disease.' While endometriosis gets most of the attention, adenomyosis — where endometrial-like tissue invades the myometrium — may affect up to 20 to 30% of women, making it potentially two to three times more common. [1] — Renato Tomioka "Adenomyosis prevalence up to 20–30%: Adenomyosis may be even more prevalent than endometriosis, affecting up to 20–30% of women, yet it rem…" 15:46 Though they share molecular features (progesterone resistance, aromatase overexpression, oncogenic mutations), single-cell transcriptomics — citing a paper by Linda Judis — shows they are distinct diseases with different pathways. The mechanism of adenomyosis is described as TIAR (tissue injury and repair): the endometrium breaches the junctional zone, typically after C-section, curettage, or miscarriage, and infiltrates the muscular wall, forming cysts and echogenic buds that enlarge and soften the uterus. Critically, up to 70% of endometriosis patients may have concurrent adenomyosis [2] — Renato Tomioka "Up to 70% of endo patients have adenomyosis: Up to 70% of women with endometriosis may also have some degree of adenomyosis, a comorbidity …" 17:18 — a co-occurrence Tomioka believes has been a hidden confounder in implantation studies. Unlike endometriosis, adenomyosis is definitively cured only by hysterectomy, making fertility preservation a fundamentally different challenge for affected women.
In deep infiltrating endometriosis and adenomyosis, up to 37% of lesions carry the same oncogenic mutations (KRAS, PIK3CA) that drive cancer growth. But fibrosis traps them. It is, biologically, a 1,000-horsepower engine inside a golf cart.
Adenomyosis may be even more prevalent than endometriosis, affecting up to 20–30% of women, yet it remains underdiagnosed and underappreciated.
Up to 70% of women with endometriosis may also have some degree of adenomyosis, a comorbidity with major implications for fertility treatment.
