adenomyosis Flashcards
(9 cards)
What is adenomyosis?
a condition where endometrial glands and stroma invade the myometrium. It often occurs between 30 and 50 years of age, and about 15% of cases are also complicated with endometriosis, while about half are complicated with uterine fibroids.
Extra Information
The invasion of the basal layer of the endometrium into the myometrium results in the growth of endometrial tissue within the muscular wall of the uterus. High levels of estrogen and progesterone can stimulate this growth.
Describe the pathological features of adenomyosis.
Ectopic endometrium grows diffusely in the myometrium (mostly involving the posterior wall), making the uterine uniformity increase and the anterior - posterior diameters increase significantly, showing a spherical shape. There are also localized forms like adenomyoma. The muscular wall of the uterus is thickened and rigid, with thick muscle fiber bands and microcapsule cavities. Under the microscope, there are islets of ectopic endometrium glands and stroma in the muscle layer, which are immature intima, having a reaction to estrogen but not to progesterone.
Extra Information: Local recurrent bleeding leads to hyperplasia of fibrous tissue around the focus, and there is no obvious boundary with the surrounding muscle layer, making it difficult to peel during surgery.
What are the main clinical manifestations of adenomyosis?
main symptoms are excessive menstruation, prolonged menstrual period, and progressive dysmenorrhea. Some patients may also have no typical symptoms. Pelvic examination may show that the uterus is uniformly increased or has a localized nodule uplift, which is hard and tender.
Extra Information: Excessive menstruation and prolonged menstrual period are related to increased endometrium area, myometrium fiber hyperplasia, poor uterine muscle layer contraction, and endometrium hyperplasia. Dysmenorrhea is caused by increased endometrial prostaglandin content, leading to vascular contracture and uterine ischemia.
How is adenomyosis diagnosed?
Diagnosis is based on medical history (excessive, prolonged periods, and progressive dysmenorrhea), physical examination (uterine uniform increase or localized uplift, hard and tender), and supplementary examinations (color Doppler ultrasound, MRI). Histology is the current method to diagnose adenomyosis, but it has problems such as lack of uniform histologic definition. Imaging examination is the most important non - surgical diagnostic method
What are the medication options for adenomyosis?
For mild symptoms, patients with fertility requirements or near menopause, medications like levonorgestrel intrauterine contraceptive system (LNG - IUS), oral contraceptives, progesterone, GnRH - a, and NSAIDs can be used. LNG - IUS can promote apoptosis of endometrial cells, convert estradiol to less active estrone, and effectively treat menorrhagia associated with endometriosis.
Extra Information: Medication can relieve symptoms but may have side effects, and symptoms can recur after withdrawal. GnRH - a can cause perimenopausal symptoms and osteoporosis risk, and its treatment course generally does not exceed 6 months.
What are the surgical treatment options for adenomyosis?
For young or fertile patients with adenomyoma, focal excision can be considered, but the risk of postoperative recurrence needs to be assessed. For patients with severe symptoms, no fertility requirements, or ineffective medication, total hysterectomy can be performed, and it is determined whether to retain the ovary according to the patient’s age and ovarian lesions.
What are the interventional therapies for adenomyosis?
Uterine arterial embolization (UAE) can be used when adenomyosis leads to massive acute uterine bleeding or when non - surgical treatment fails. High - intensity focused ultrasound (HIFU) is a non - invasive treatment for symptomatic adenomyosis with certain requirements like a muscle wall thickness at the lesion > 3 cm and successful positioning of airborne imaging equipment.
Extra Information: UAE works by embolizing bilateral uterine arteries to cause ischemia, hypoxia, necrosis, and absorption of ectopic endometrial tissue. HIFU uses ultrasonic energy to heat and coagulate lesion tissue while sparing surrounding tissue.
How should adenomyosis be managed?
Adenomyosis should be treated based on symptoms, age, and fertility requirements. First - line treatment is usually medication. For patients with severe symptoms or those unresponsive to medication, surgical or interventional treatments can be considered. Long - term management with drugs like GnRH - a combined with other medications can reduce postoperative recurrence
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Extra Information: Patient education about menstrual - related knowledge, adenomyosis symptoms, and treatment options is also an important part of management.
