When Dr. Alison Maclean looked at tissue from a uterus under a powerful microscope for the first time, she saw something researchers had never documented before. Deep inside adenomyosis lesions, she and her team at the University of Liverpool discovered a unique biological fingerprint — a set of molecular signals that make diseased tissue distinctly different from the healthy tissue surrounding it. That discovery, published in the journal Science Advances, could change how doctors treat a condition that affects roughly 1 in 5 women of reproductive age worldwide.
Adenomyosis happens when tissue similar to the womb's lining grows into the muscle of the uterus. It causes heavy bleeding, severe cramping, and sometimes fertility struggles. For decades, women with the condition had few options: hormone therapies that prevent pregnancy, or surgery to remove the uterus entirely. But Dr. Maclean's research suggests a gentler path forward may exist.
"By identifying the features that distinguish diseased tissue from healthy tissue, we are laying the groundwork for treatments that could directly target the condition while preserving the uterus and normal womb lining," said Dr. Maclean, a National Institute for Health and Care Research clinical lecturer who led the study during her Medical Research Council fellowship.
The Liverpool team used a technique called spatial transcriptomics — essentially, a way to see which genes are switched on in different cells while keeping the tissue structure intact. It was the first time this method had ever been applied to human uterine tissue, and it allowed researchers to compare sick and healthy tissue from the same uterus side by side.
What they found was striking. The lesions weren't just random patches of misplaced tissue. They had a clear molecular identity, and they shared features with the deeper, more stable layer of the womb lining — information that may explain how adenomyosis develops and why it persists. The team also spotted signs of ongoing inflammation and altered energy production in the diseased areas, processes that likely contribute to the pain and heavy bleeding patients experience.
Perhaps most exciting, the researchers used their molecular data to identify several existing medications and experimental drugs that might reverse the biological changes driving adenomyosis. Clinical trials would still be needed, but the finding offers real hope that women could someday take a pill instead of facing major surgery. The goal, Dr. Maclean said, is to help women avoid surgery and protect their fertility where possible.
The study was conducted in Professor Dharani Hapangama's gynecology research group at Liverpool. While adenomyosis has historically received limited research attention despite its prevalence, this work adds it to a growing list of conditions where understanding disease at the molecular level is opening doors to smarter, more targeted treatments.