Adenomyosis/ endometriosis interna

Question 1

Definition

Answer 1

Presence of endometrial glands and stroma in the myometrium making the uterus diffusely enlarged, boggy and globular

Question 3

risk factors

Answer 3

hysterectomy, parity, age, no of abortions, surgery of uterine cavity, uterine malformation, menorrhagia

Question 4

Clinical manifestations

Answer 4

1. asymptomatic
2. Dysmenorrhea
3. Non cyclic pelvic pain
4. Abnormal uterine bleeding
5. Infertility
6. Enlarged uterus

Question 5

What are the 2 types of adenomyosis

Answer 5

1. focal adenomyosis
2. diffuse adenomyosis

Question 6

Pathogenesis

Answer 6

Presence of endometrial tissue in the myometrium atleast 1 low magnification field of view from the endometrium - muscular junction zone

Question 7

Histopathology

Answer 7

1. Myometrial hypertrophy n proliferation
2. High level of estrogen - stimulated hyperplasia of the basalis layer of endometrium
3. barrier bw myometrium and endometrium is broken and endometrial cells invade the myometrium

Question 8

Most common in which part?

Answer 8

Fundus and posterior uterine wall

Question 9

Diagnosis

Answer 9

1. Typical symptoms such as dysmenorrhea and heavy bleeding
2. uterine enlargement in gyn examination
3. ultrasound more than 80% accurate
4. MRI - most accurate tool

Question 10

What is the best tool to distinguish between adenomyosis and leiomyoma?

Answer 10

MRI

Question 11

What is the definitive method for the diagnosis and treatment of adenomyosis?

Answer 11

Hysterectomy

Question 12

Medical treatment options

Answer 12

1. GnRH agonists
2. Progestins - dienogest
3. Oral contraceptives
4. Danazol

Question 13

Non surgical techniques

Answer 13

1. Uterine artery embolization (UAE)
   2.High intensity focused ultrasound (HIFU)

Question 14

Surgical techniques

Answer 14

1. Adenomyomectomy - double flap method
2. Hysterectomy - total hysterectomy is the only definitive treatment of adenomyosis