Adenomyosis

Question 1

Adenomyosis definition

Answer 1

The presence of heterotropic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia
Unknown aetiology

Question 2

Clinical presentation of adeno

Answer 2

Menorrhagia
Dysmenorrhea
Irregular bleeding
Dyspareunia
Dyschezia
Chronic pelvic pain
Subfertility 

Exam may be normal, or may reveal an enlarged and/or tender uterus

Question 3

MRI signs of adeno

Answer 3

Thickening of the endo-myometrial junctional zone

85% sensitivity/specificity

Question 4

USS features of adenomyosis

Answer 4

A mottled homogenous myometrial texture
Globular appearaing uterus
Small cystic spaces within the myometrium
“Shaggy” indistinct endometrial stripe

Question 5

How does it cause menorrhagia

Answer 5

Increased overall uterine surface area

Dysfunctional hypertrophied muscle prevent uterine contraction from temps adding myometrial arterioles

Question 6

How does it cause dysmenorrhoea

Answer 6

Endometrial tissue infiltrates into the myometrium
Spiral vessel angiogenesis takes place and results in bleeding within the myometrium at menstruation, causing a related inflammatory reaction and pain

Question 7

Prevalence

Answer 7

8.8-30%