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Updated: Nov 29 2021

Adenomyosis

  • Snapshot
    • A 43-year-old woman who is Gravida 3, Para 2 and Aborta 1, presents with increasing, worsening pain with menses, along with progressively heavier menstrual bleeding. Pelvic examination reveals a diffusely enlarged, tender, and boggy uterus. Serum β-hCG is negative. Transvaginal sonogram showed an enlarged uterus with a thickened posterior myometrium (arrows).
  • Summary
    • Invasion of endometrial glands into uterine myometrium
  • EPIDEMIOLOGY
    • women ages 35-50
  • Etiology
    • Pathogenesis
      • largely unknown
    • Associated conditions
      • often coexists with other uterine diseases
        • leiomyomas
        • endometriosis
  • Presentation
    • Symptoms
      • dysmenorrhea
      • menorrhagia
      • chronic pelvic pain
    • Physical exam
      • uterus is
        • uniformly smooth
        • large
        • soft
        • globular
        • boggy
        • tender
  • Imaging
    • Sonogram
      • sensitivity of 72% and specificity of 81%
    • MRI (T2-weighted)
      • sensitivity of 77% and specificity of 89%
      • best used when trying to exclude malignant neoplasia
      • both modalities show diffusely enlarged uterus with some cystic areas within myometrium
  • Studies
    • Initial test to order in patient with enlarged uterus
      • β-hCG
  • Differential Diagnosis
    • Leiomyoma
    • Pregnancy
    • Endometrial polyp
  • Diagnosis
    • Diagnosis is based on clinical history and exam
    • Definitive diagnosis
      • hysterectomy and histology
  • Treatment
    • Symptomatic treatment for dysmenorrhea
      • levonorgestrel-releasing intrauterine contraception
      • aromatase inhibitors
    • When fertility is no longer needed or failure of medical therapy
      • hysterectomy
  • Complications
    • Controversial evidence linking adenomyosis with infertility
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