Adenomyosis’ association with low progesterone yet increased interleukin-6, vascular endothelial growth factor and cyclooxygenase-2

• Higher VAS scale is observed in those with adenomyosis. • Adenomyosis is associated with low progesterone environment. • IL-6, VEGF and COX-2 is found increased in adenomyosis. • Heightened inflammatory profile highlights the pro-inflammatory pathogenesis of adenomyosis. Adenomyosis is associated with aberrant hormonal and mediator profiles.This study aims to investigate the relationship between dysmenorrhea severity and progesterone B receptor (PR-B); vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2) and interleukin-6 (IL-6) in adenomyosis and nonadenomyosis. This was a cross-sectional study. Consecutive sampling was performed 20/08/2021−30/06/2022. The adenomyosis group recruited patients presenting with secondary dysmenorrhea, aged 20–42 years old, having undergone surgery for adenomyosis with subsequent histologic confirmation. The control group recruited. patients with a similar age bracket, having undergone hysterectomy for ovarian cysts and/or early-stage cervical cancer. We excluded patients with uterine fibroids, endometrioma, uterine malignancy and pelvic inflammatory diseases. Dysmenorrhea severity was assessed using visual analogue scale (VAS). Enzyme-linked immunosorbent assay measured the expression of PR-B, IL-6, VEGF and COX-2. Sixty patients were recruited, consisting of 30 adenomyosis and 30 controls. Adenomyosis patients reported higher median VAS on dysmenorrhea. Adenomyosis patients had significantly lower PR-B receptor levels (0.951 vs. 11.105, p < 0.001) but higher COX-2 levels (0.718 vs. 0.315, p = 0.001). There were no significant differences in VEGF (73.375 vs. 66.42, p = 0.496) and IL-6 (0.608 vs. 0.48, p = 0.824). Among adenomyosis patients, there is a significant positive correlation between VEGF level and COX-2 level ( r = 0.583; p = 0.001), VEGF level and IL-6 level ( r = 0.590; p = 0.001), COX-2 and IL-6 levels ( r = 0.491; p = 0.006). There were no statistically significant correlations between severity of dysmenorrhea and PR-B; VEGF; IL-6 and COX- 2. There was no correlation between the severity of dysmenorrhea and PR-B receptor, VEGF; IL-6 and COX-2 levesl. Adenomyosis is associated with low progesterone environment but heightened inflammatory profile: increased IL-6, VEGF and COX-2.