Adenomyosis

Chapter 107 Adenomyosis



INTRODUCTION



Description: Adenomyosis is characterized by endometrial glands and stroma found in the uterine wall (myometrium).

Prevalence: Ten percent to 15% of women; may be 60% in women 40 to 50 years old.

Predominant Age: 35 to 50.

Genetics: Familial predisposition (polygenic or multifactorial inheritance pattern).


ETIOLOGY AND PATHOGENESIS



Causes: Adenomyosis is derived from aberrant glands of the basalis layer of the endometrium. These grow by direct extension into the myometrium.

Risk Factors: High levels of estrogen (postulated), high parity, postpartum endometritis (postulated). Local endometrial invasion may be seen following cesarean delivery, myomectomy, or curettage.


CLINICAL CHARACTERISTICS



Signs and Symptoms



• Asymptomatic (40%)

• Menorrhagia (40% to 50%) often increasing in severity

• Dysmenorrhea

• Symmetric “woody” enlargement of the uterus (up to two to three times normal)

• Uterine tenderness that varies with the cycle (worst just before menstruation)


DIAGNOSTIC APPROACH



Differential Diagnosis



• Uterine leiomyomata (most often resulting in asymmetric uterine changes)

• Endometrial polyp

• Endometrial hyperplasia

• Endometrial cancer

• Endometriosis (when pain is predominant symptom)


Associated Conditions: Coexistent endometriosis (15%), uterine leiomyomata, dyspareunia, salpingitis isthmica nodosa.


Workup and Evaluation



Laboratory: No evaluation indicated, complete blood count if anemia is suspected.

Imaging: No imaging indicated except to rule out other possible pathologic conditions. Either transvaginal ultrasonography or magnetic resonance imaging (MRI) may demonstrate abnormalities. (On ultrasound, the uterus will have a heterogeneous texture, without focal abnormalities.) MRI (T2-weighted or contrast-enhanced T1-weighted) will be more specific than ultrasonography.

Related posts:

  1. Anemia
  2. Toxic Shock Syndrome
  3. Uterine Anomalies: Bicornuate, Septate, and Unicornuate Uterus
  4. Breast: Intraductal Papilloma

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 6, 2016 | Posted by in GYNECOLOGY | Comments Off on Adenomyosis

Full access? Get Clinical Tree
Get Clinical Tree app for offline access