Adenomyosis

Adenomyosis is a noncancerous gynecologic condition characterized by the existence of endometrial-like tissue within the uterine myometrium. It is most commonly identified in women between 35 years of age and menopause.

The typical symptoms are dysmenorrhea, menorrhagia, dyspareunia, and chronic pelvic pain. On examination, a bulky, tender, diffusely enlarged uterus is highly suggestive of the diagnosis. Adenomyosis may also be asymptomatic and diagnosed incidentally as part of investigations for infertility or following hysterectomy.

Transvaginal ultrasound is the first-line investigation to confirm an imaging-supported diagnosis. Definitive diagnosis relies on histopathologic confirmation of endometrial stroma and glandular tissue in the smooth muscle of the myometrium, usually following hysterectomy.

Treatment is dependent on the type and severity of symptoms, patient preference, and the desire to preserve fertility. The levonorgestrel intrauterine device (IUD) is the preferred first-line medical treatment, although alternative hormonal therapies can also be used. A nonsteroidal anti-inflammatory drug (NSAID) or tranexamic acid may be used alone for mild symptoms or in combination with hormonal treatment if symptoms persist or recur.

Hysterectomy is a definitive treatment option for women with severe symptoms who do not desire future fertility. Endometrial ablation or uterine artery embolization are alternative approaches for patients who wish to preserve their uterus or are unsuitable for hysterectomy. Uterine-sparing focal excision procedures may be considered in women with severe adenomyotic disease who desire preservation of fertility, but this is a challenging surgical technique with uncertain fertility outcomes.

Adenomyosis is a noncancerous (benign) gynecologic condition characterized by the existence of endometrial-like tissue within the uterine myometrium. Adenomyosis may be described as focal or diffuse; in focal disease, nodular aggregates of endometrial glands and stroma are surrounded by normal myometrium, whereas in diffuse disease there are endometrial glands and stroma distributed throughout the myometrium.[1]Van den Bosch T, de Bruijn AM, de Leeuw RA, et al. Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2019 May;53(5):576-82. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.19096 http://www.ncbi.nlm.nih.gov/pubmed/29790217?tool=bestpractice.com