Immunoreactivity of Plasminogen Activator Inhibitor 1 and Its Correlation with Dysmenorrhea and Lesional Fibrosis in Adenomyosis

Reprod Sci. 2021 Aug;28(8):2378-2386. doi: 10.1007/s43032-021-00513-6. Epub 2021 Mar 8.


Adenomyosis is associated with dysmenorrhea, infertility, and lesional fibrosis. The pathogenesis of adenomyosis is still unclear. Plasminogen activator inhibitor 1 (PAI-1) plays important roles in pathological activities like tumor metastasis and endometriosis. Our objective was to investigate the expression and localization of PAI-1 in eutopic and ectopic endometrium with adenomyosis and in endometrium without adenomyosis. We also sought to determine the relationship between PAI-1 immunoreactivity and the severity of dysmenorrhea and the extent of lesional fibrosis in adenomyosis. PAI-1 expression was significantly higher in the ectopic endometrium of patients with adenomyosis than in both the eutopic endometrium of patients with adenomyosis and the endometrium of controls. Ectopic PAI-1 expression correlated positively with dysmenorrhea visual analog scale (VAS) scores and the extent of lesional fibrosis in adenomyosis. High PAI-1 expression increased the likelihood of moderate to severe dysmenorrhea in adenomyosis. These results suggest that PAI-1 is involved in the adenomyosis-associated dysmenorrhea and lesional fibrosis, which provide a potential target in treating symptomatic adenomyosis.

Keywords: Adenomyosis; Dysmenorrhea; Fibrosis; Immunohistochemistry; PAI-1.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenomyosis / metabolism*
  • Adenomyosis / pathology
  • Adult
  • Dysmenorrhea / metabolism*
  • Dysmenorrhea / pathology
  • Endometrium / metabolism*
  • Endometrium / pathology
  • Female
  • Fibrosis / metabolism
  • Fibrosis / pathology
  • Humans
  • Immunohistochemistry
  • Middle Aged
  • Plasminogen Activator Inhibitor 1 / metabolism*


  • Plasminogen Activator Inhibitor 1