Adenomyosis

Question 1

What is adenomyosis?

Answer 1

-adenomyosis refers to endometrial tissue inside the myometrium

Question 2

Describe the epidemiology of adenomyosis

Answer 2

• more common in later reproductive years and those who have had multiple pregnancies (multiparous)
• occurs in around 10% of women
• can occur alone or along endometriosis and fibroids

Question 3

Describe the aetiology of adenomyosis

Answer 3

• cause not fully understood
• multiple factors involved including sex hormones, trauma and inflammation
• condition is hormone dependent with symptoms usually resolving after menopause, similarly to endometriosis and fibroids

Question 4

Describe the presentation of adenomyosis

Answer 4

around a third of pts asymptomatic

• painful periods (dysmenorrhagia)
• heavy periods (menorrhagia)
• Pain during intercourse (dyspareunia)
• infertility

Question 5

What might examination show for adenomyosis?

Answer 5

• enlarged and tender uterus

- will feel more soft than a uterus containing fibroids

Question 6

What investigations would you do to diagnose adenomyosis?

Answer 6

• transvaginal US of pelvis is firs-tline
• MRI and transabdo US can be used if transvaginal US not acceptable
• gold standard is to perform a histological examination after a hysterectomy but this is not usually done for obvious reasons

Question 7

What does management of adenomyosis depend on?

Answer 7

• symptoms
• age
• plans for pregnancy

Question 8

What is the management of adenomyosis the same as?

Answer 8

same as management for menorrhagia

Question 9

What is the management for adenomyosis if contraception is not accepted?

Answer 9

treatment during menstruation for symptomatic relief with:

• transexamic acid when there is no pain
• mefenamic acid (NSAID) where there is pain

Question 10

What is the management for adenomyosis if contraception is accepted?

Answer 10

• mirena coil (first line)
• combined OCP
• cyclical oral progestogens

Question 11

What other management options may be considered?

Answer 11

• gnRH agonists
• endometrial ablation
• uterine artery embolisation
• hysterectomy

Question 12

How can adenomyosis affect pregnancy?

Answer 12

• Infertility
• Miscarriage
• Preterm birth
• Small for gestational age
• Preterm premature rupture of membranes
• Malpresentation
• Need for caesarean section
• Postpartum haemorrhage