Aim:
To determine and characterise changes associated with microbial, inflammatory and immune factors in patients with adenomyosis.

Material and methods:
115 female patients were enrolled in the study, including 85 patients with adenomyosis and 30 healthy individuals. Vaginal cleanliness was assessed by collecting vaginal samples and plating on solid bacterial agar. Urogenital infections were determined by the PCR analysis of the cervicovaginal samples. The immunological characterisation was performed using enzyme immunoassay to analyse cervicovaginal lavage for β-defensin-2 and a defined set of cytokines. Antibody titers were quantified in patients’ serum using nephelometry.

Results:
Patients with adenomyosis displayed disrupted cervicovaginal microflora that was characterised by elevated levels of pro-inflammatory cytokines and antimicrobial peptide β-defensin-2. Serum analysis of patients with adenomyosis revealed higher concentration of IgG, IgM and IgA antibodies compared to healthy control groups.

Conclusions:
Analysis of inflammatory and immunological parameters in patients with adenomyosis revealed distinct features of the pathophysiology of adenomyosis. Specifically, patients with adenomyosis had disrupted cervicovaginal microflora with higher prevalence of anaerobic species. Furthermore, patients with adenomyosis had elevated levels of pro-inflammatory cytokines and interleukins in cervicovaginal lavage, and higher levels of IgG, IgM and IgA antibody serum titres. The analysis presented in the paper represents an important step towards determining precise diagnostic parameters and effective therapies to treat adenomyosis.