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Adenomyosis
Aka: Adenomyosis, Endometriosis of Uterus
- See Also
- Abnormal Uterine Bleeding
- Endometriosis
- Pelvic Pain
- Uterine Fibroids
- Dysmenorrhea
- Definitions
- Adenomyosis
- Endometrial glands embedded within the uterine myometrium
- Contrast with Endometriosis, in which endometrial glands are embedded in tissue outside the Uterus
- Risk Factors
- Multiparous women
- Age over 40 years old
- Prior cesarean delivery
- Prior uterine surgery
- Epidemiology
- Incidence: 1% (29 per 10,000 person years over 10 years)
- Symptomatic in >90% of cases in this series
- Yu (2020) Am J Obstet Gynecol 223(1): 94 [PubMed]
- Prevalence data is highly variable
- Original Prevalence of 10 to 35% was obtained from Hysterectomy tissue samples
- However, there are no standardized histologic criteria for the Adenomyosis diagnosis
- One Ultrasound-based study in symptomatic women identified Adenomyosis in 20%
- Naftalin (2012) Human Reprod 27(12):3432-9 [PubMed]
- Prevalence varies by age
- Overall Prevalence (female patients of all ages): 0.8%
- Age 41 to 45 years old (peak age): 1.5%
- Pathophysiology
- Endometrial glands and stroma embed within the myometrium of the Uterus
- Colloquially known as Endometriosis of the Uterus (or internal Endometriosis)
- Pathogenesis theories
- Basalis endometrium, on injury, invaginates into the myometrium via an interrupted junctional zone OR
- Metaplasia of pluripotent Mullerian duct remnants
- Types
- Diffuse involvement of myometrium
- Focal
- Symptoms
- Asymptomatic in one third of patients
- Symptom onset typically at age 40 to 50 years old
- Dysmenorrhea (Painful Menstrual Periods, occurring in 15 to 30% of patients)
- May be worse in comorbid Uterine Fibroids
- Menorrhagia (heavy menstrual periods, occurring in 40-60% of patients)
- Metrorrhagia (prolonged menstrual periods)
- Other more variable symptoms
- Dyspareunia
- Chronic Pelvic Pain
- Infertility
- Signs
- Enlarged Uterus that is tender and boggy
- Associated Conditions
- Uterine Fibroids (50%)
- Endometriosis (11%)
- Differential Diagnosis
- See Abnormal Uterine Bleeding Causes
- See Dysmenorrhea
- See Chronic Pelvic Pain Causes
- See Dyspareunia
- Imaging
- Transvaginal Ultrasound
- Efficacy
- Test Sensitivity: 83.8%
- Test Specificity: 63.9%
- Findings
- Globular Uterus
- Fan-shaped shadowing
- Indistinct margin between outer myometrium and junctional zone
- Cystic changes involve the junctional zone and myometrium
- Hyperechoic islands within the junctional zone
- References
- Andes (2018) J Minim Invasive Gynecol 25(2): 257-64 [PubMed]
- MRI Pelvis
- Indicated in non-diagnostic Ultrasound
- Test Sensitivity: 77%
- Test Specificity: 89%
- Bazot (2018) Fertil Steril 109(3): 389-97 [PubMed]
- Liu (2021) J Ultrasound Med 40(11): 2289-306 [PubMed]
- Hysteroscopy
- Hypervascularization
- Endometrial defects
- Submucosal hemorrhagic cysts
- Management
- Non-surgical symptomatic management
- See Dysmenorrhea
- NSAIDs
- Hormonal management
- Oral Contraceptives
- Progestin-Releasing IUD (e.g. Mirena)
- Gonadotropin-Releasing Hormone analogues and antagonists
- Surgical Management
- Hysterectomy (80% of women with Adenomyosis)
- Uterine artery embolization
- References
- Osayande (2014) Am Fam Physician 89(5): 341-6 [PubMed]
- Schrager (2022) Am Fam Physician 105(1): 33-8 [PubMed]
- Taran (2013) Geburtshilfe Frauenheilkd 73(9):924-31 +PMID: 24771944 [PubMed]