Adenomyosis is a benign condition characterized by ingrowth of the endometrium (inner lining of the uterus) into the uterine muscle layer or myometrium. The incidence may approach 60% in women 40 to 50 years of age. Symptomatic adenomyosis usually presents in women 35 to 50 years of age. Two out of three women with adenomyosis have coexistent pelvic pathology, most commonly myomas (fibroids) but also endometriosis and endometrial hyperplasia. A typical uterus with adenomyosis is uniformly enlarged and weighs more than 100 grams (normal uterus weighs 80-100 grams). Adenomyosis occurs more frequently in women who have had several children.
Causes
1. The cause of adenomyosis is unknown. 2. Adenomyosis usually occurs in women over 30 years of age who have borne children.
Symptoms
1. Secondary painful menstruation 2. Prolonged, irregular menstrual bleeding 3. Painful intercourse 4. Pelvic pain 5. The majority of women have no symptoms or minimal symptoms.
Diagnosis
1. Pathological examination of uterus (can only be done after hysterectomy) 2. Pelvic examination finds an enlarged, softened uterus. 3. Abdominal MRI 4. Pelvic ultrasonography
Treatment
1. Pain medications 2. GnRH (gonadotropin-releasing hormone) agonists to prevent menstrual cycles and, thus, pain 3. Most treatment attempts with hormones, such as birth control pills or Depo-Provera, have been unsuccessful. 4. Hysterectomy is the definitive treatment if appropriate for the women's age, parity, and future childbearing plans.
