Sep 15, 2025
In this thought-provoking episode, Dr. Nicholas Fogelson and Dr. Shanti Mohling delve into new research that challenges how we understand adenomyosis in relation to endometriosis. They break down the proposed subtypes of adenomyosis— from interna and externa to intramural and adenomyomas— and discuss how these patterns may arise from childbirth, uterine surgery, or molecular changes shared with endometriosis. Along the way, they revisit century-old theories, weigh the evidence for different pathways of disease development, and explore what this means for treatment decisions, fertility preservation, and patient pain.
Highlights:
- Defining adenomyosis and how it differs from—and overlaps with—endometriosis
- Subtypes of adenomyosis: interna, externa, intramural, and adenomyomas
- Theories of origin: tissue injury and repair, retrograde menstruation, embryonic remnants, and genetic mutations
- Why hysterectomy can sometimes relieve pain when conservative surgery cannot
- Understanding why patients with minimal disease may have severe pain while others with advanced disease experience little or none
For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at newpatients@nwendometriosis.com
Follow us on Instagram: @Nicholasfogelson and @drshantimohling
Download a transcript of this episode.