Adenomyosis

Introduction

• Description: Adenomyosis is characterized by islands of endometrial glands and stroma found in the uterine wall (myometrium) and causing hypertrophy of the surrounding myometrium.

• Prevalence: 10%–35% of women; may be present in 60% of aged women 40–50 years.

• Predominant Age: 35–50 years.

• 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. A metaplastic process or de novo growth from Müllerian rests may also account for glandular growth.

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

Signs And Symptoms

• Asymptomatic (40%)

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

• Dysmenorrhea

• Symmetric “boggy” or “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