Adenomyosis

Original Editor - Kehinde Fatola
Top Contributors - Kehinde Fatola

Introduction

Adenomyosis is a condition in which the endometrium (glandular tissue) of the uterus breaks ectopically through the myometrium (muscular wall) of the uterus making the uterine walls thicker and distorting the vasculature of the uterus. It is formerly referred to as endometriosis interna, but it has been found that the two diseases differ though they may occur together.

The disease is more prevalent in multiparous middle-aged women, it may also occur in the younger population. Adenomyosis is thought to be hormone-sensitive and estrogen, progesterone, prolactin, and follicle stimulating hormone are implicated, it is also known to subside after menopause when hormone levels decline.

Mechanism of Injury / Pathological Process

Adenomyosis is of unknown aetiology. However, some processes have been implicated which include;

• Invasion of the endometrium into the myometrium
• Inflammation of the uterine walls during childbirth
• Exttraneous tissues present in the uterine wall in utero and grow at adulthood.
• Myometrial stem cells
• Uterine trauma arising from pregnancy, ceaseran section or pregnancy termination
  

Clinical Presentation

Symptoms of adenomyosis can range from mild, moderate or severe, while some people may not experience any at all. The commonest include:

• Menorrhalgia
• Menorrhagia
• Blood clots during menstrual bleeding
• Dyspareunia
• Infertility
  

Diagnostic Procedures

Ultrasound: The most available and cheapest diagnostic method of adenomyosis

Magnetic Resonance Imaging (MRI: Increased soft tissue distinction, made possible by enhanced spatial and contrast resolution, allows MRI to provide superior diagnostic capabilities. Other variables limit MRI, however calcified uterine fibroids do not (as is ultrasound). MRI is especially good at distinguishing adenomyosis from many tiny uterine fibroids.

Management / Interventions

• Hysterectomy
• Laparoscopic myometrial electrocoagulation
• Levonogestrel-releasing intrauterine devices
• Adenomyoma excision
• NSAIDs
• Endometrial ablation
• Pelvic floor exercises (kegel & tailor)

Differential Diagnosis

• Endometrial polyps
• Submucosal fibroids
• Endometrial hyperplasia
• Endometrial carcinoma