Adenomyosis

Adenomyosis is the uterine glandular and stromal tissue growth in the uterine musculature—the ectopic tissue results in uterine enlargement to almost three times its size.

Prevalence

-It is common in women aged between 35 to 50 years.

-Higher parity increases the risk of adenomyosis

-It tends to occur with other comorbid conditions such as endometriosis and uterine leiomyomas

Signs and symptoms

The symptoms may resolve after menopause.

• Heavy menstrual flow
• Dysmenorrhea
• Diffuse pelvis pain
• Pressure symptoms- increased urinary frequency and painful defecation
• Dyspareunia
• Anemia- due to increased blood loss during menses

Diagnosis

Clinical evaluation( pelvic exam) and relevant history of the patient

Imaging

• Pelvic Ultrsonoghraphy- transvaginal
• MRI- visualize the extent of the implantation
• Histological studies of biopsy after hysterectomy- definitive diagnosis

Differential diagnoses

1. Dysmenorrhea
2. Endometriosis
3. Endometrial polyps
4. Endometrial carcinoma

Treatment

Surpotive –Analgesics eg NSAIDs

Surgical removal in severe cases-hysterectomy

Hormonal therapy, e.g., oral contraceptives- low success rate