Original Editor - Kehinde Fatola
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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. [1] It is formerly referred to as endometriosis interna, but it has been found that the two diseases differ though they may occur together. [2]

The disease is more prevalent in multiparous middle-aged women, it may also occur in the younger population. [3]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; [4]

  • 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: [5]

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

Diagnostic Procedures[edit | edit source]

Ultrasound: The most available and cheapest diagnostic method of adenomyosis. [6]

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. [7]

Management / Interventions[edit | edit source]

  • Hysterectomy
  • Laparoscopic myometrial electrocoagulation
  • Levonogestrel-releasing intrauterine devices
  • Adenomyoma excision
  • NSAIDs
  • Endometrial ablation

Physiotherapy Management[edit | edit source]

Physiotherapy management in adenomyosis involves the general pelvic floor management which includes the Kegels and Tailor's Exercises.

  • Kegel Exercises help strengthen the muscles that support the bladder, uterus, and bowels. By strengthening these muscles during your pregnancy, you can develop the ability to relax and control the muscles in preparation for labor and birth. Kegel exercises are also highly recommended during the postpartum period to promote the healing of perineal tissues, increase the strength of the pelvic floor muscles, help these muscles return to a healthy state, and increase urinary control.

To do Kegels, imagine you are trying to stop the flow of urine or trying not to pass gas. When you do this, you are contracting the muscles of the pelvic floor and are doing Kegel exercises. Try not to move your leg, buttock, or abdominal muscles. In fact, no one should be able to tell that you are doing Kegel exercises. You can do them anywhere!

Try to do five sets of Kegel exercises a day. Each time you contract the muscles of the pelvic floor, hold for a slow count of five and then relax. Repeat this 10 times for one set of Kegels.

  • Tailor Exercises strengthen the pelvic, hip, and thigh muscles and can help relieve low back pain.

Tailor sit. Sit on the floor with your knees bent and ankles crossed. Lean slightly forward, and keep your back straight but relaxed. Use this position whenever possible throughout the day.

Tailor press. Sit on the floor with your knees bent and the bottoms of your feet together. Grasp your ankles and pull your feet gently toward your body. Place your hands under your knees. Inhale. While pressing your knees down against your hands, press your hands up against your knees (counter-pressure). Hold for a count of five.

Differential Diagnosis
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References[edit | edit source]

  1. Sanaz Ghazal. Healthline. Understanding Adenomyosis, a Uterine Condition. Available from; Accessed on 09/05/2022
  2. Maheshwari, A.; Gurunath, S.; Fatima, F.; Bhattacharya, S. (2012). "Adenomyosis and subfertility: A systematic review of prevalence, diagnosis, treatment and fertility outcomes". Human Reproduction Update 18 (4): 374–392. doi:10.1093/humupd/dms006
  3. Brosens, I., et al., Uterine Cystic Adenomyosis: A Disease of Younger Women. J Pediatr Adolesc Gynecol, 2014.
  4. Florence Bryd. WebMD. What is Adenomyosis? Available from; Accessed on 09/05/2022
  5. Shrestha, A., et al., Adenomyosis at hysterectomy: prevalence, patient characteristics, clinical profile and histopatholgical findings. Kathmandu Univ Med J (KUMJ), 2012. 10(37): p. 53-6.
  6. Lazzeri L, Di Giovanni A, Exacoustos C et al. Preoperative and postoperative clinical and transvaginal ultrasound findings of adenomyosis in patients with deep infiltrating endometriosis. Reprod. Sci. doi:10.1177/1933719114522520 (2014) (Epub ahead of print).
  7. Maheshwari, A., et al., Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update, 2012. 18(4): p. 374-92.