6. Adenomyosis

Question 1

Define: Adenomyosis (2)

Answer 1

• Extension of areas of endometrial glands and stroma into the myometrium
• synonym: “endometriosis interna” (uterine wall may be diffusely involved)

Question 2

Describe epidemiology: Adenomyosis (3)

Answer 2

• 15% of females >35 yr old; found in 20-40% of hysterectomy specimens
• mean age at presentation: 40-50 yr old (older age group than seen in endometriosis)
• adenomyosis is a common histologic finding in asymptomatic patients

Question 3

Describe clinical features: Adenomyosis (5)

Answer 3

• often asymptomatic
• heavy menstrual bleeding, secondary dysmenorrhea, pelvic discomfort
• dyspareunia, dyschezia
• uterus symmetrically bulky, usually <14 cm
• Halban sign: tender, softened uterus on premenstrual bimanual exam

Question 4

Describe investigations: Adenomyosis (3)

Answer 4

• clinical diagnosis
• U/S or MRI can be helpful
• endometrial sampling to rule out other pathology

Question 5

Describe medical tx: Adenomyosis (6)

Answer 5

• iron supplements for anemia
• analgesics, NSAIDs
• Mirena® IUS
• CHC, medroxyprogesterone (Depo-Provera®) – limited evidence for efficacy
• GnRH agonists (e.g. leuprolide (Lupron ®))
• low dose danazol 100-200 mg PO OD (trial x 4 mo)

Question 6

Describe surgical tx: Adenomyosis (1)

Answer 6

definitive: hysterectomy – treatment of choice in women who have completed childbearing

Question 7

Final diagnosis of adenomyosis is based on what? (1)

Answer 7

on pathologic findings, but predictably identified on MRI