Adenomyosis: Difference between revisions
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== Introduction == | == 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. | 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.<br> | 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 [[Hormones|hormone]] are implicated, it is also known to subside after [[menopause]] when hormone levels decline.<br> | ||
== Mechanism of Injury / Pathological Process == | == Mechanism of Injury / Pathological Process == | ||
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* Invasion of the endometrium into the myometrium | * Invasion of the endometrium into the myometrium | ||
* Inflammation of the uterine walls during childbirth | * Inflammation of the uterine walls during [[Childbirth and the Pelvic Floor|childbirth]] | ||
* | * Extraneous tissues present in the uterine wall in utero and grow at adulthood. | ||
* Myometrial stem cells | * Myometrial stem cells | ||
* Uterine trauma arising from pregnancy, ceaseran section or pregnancy termination<br> | * Uterine trauma arising from pregnancy, ceaseran section or [[Pregnancy Related Pelvic Pain|pregnancy]] termination<br> | ||
== Clinical Presentation == | == Clinical Presentation == | ||
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== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Ultrasound: The most available and cheapest diagnostic method of adenomyosis | [[Ultrasound Scans|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.<br> | [[MRI Scans|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.<br> | ||
== Management / Interventions == | == Management / Interventions == | ||
* Hysterectomy | * [[Hysterectomy]] | ||
* Laparoscopic myometrial electrocoagulation | * Laparoscopic myometrial electrocoagulation | ||
* Levonogestrel-releasing intrauterine devices | * Levonogestrel-releasing intrauterine devices | ||
* Adenomyoma excision | * Adenomyoma excision | ||
* NSAIDs | * [[NSAIDs]] | ||
* Endometrial ablation | * Endometrial ablation | ||
* Pelvic floor exercises (kegel & tailor) | * Pelvic floor exercises ([[Kegel's Exercise : Females|kegel]] & tailor) | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
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* Submucosal fibroids | * Submucosal fibroids | ||
* Endometrial hyperplasia | * Endometrial hyperplasia | ||
* Endometrial carcinoma<br> | * [[Endometrial Cancer|Endometrial carcinoma]]<br> | ||
== References == | == References == | ||
Revision as of 14:39, 18 May 2022
Introduction[edit | edit source]
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[edit | edit source]
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
- Extraneous 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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
- Hysterectomy
- Laparoscopic myometrial electrocoagulation
- Levonogestrel-releasing intrauterine devices
- Adenomyoma excision
- NSAIDs
- Endometrial ablation
- Pelvic floor exercises (kegel & tailor)
Differential Diagnosis
[edit | edit source]
- Endometrial polyps
- Submucosal fibroids
- Endometrial hyperplasia
- Endometrial carcinoma
