Uterine Adenomyosis
Definition:
It is when the endometrial glands and stroma are present within the muscular wall of the uterus.
It usually resolves after menopause.
Adenomyosis presents in 20 – 35% of women.
Symptoms:
It can be asymptomatic, but it also can cause:
- Severe cramps during menstruation.
- Heavy menstrual bleeding.
- Prolonged menstrual period.
- Uterine enlargement.
- Lower abdomen tenderness.
- Pelvic pressure.
Causes:
The causes of Adenomyosis is still unknown but some theories indicate that it is results from:
a. Direct invasion of endometrial cells into the uterine muscles due to uterine incision such as C-section.
b. Uterine growth when fetus forming.
c. Inflammation of the uterine lining after delivery.
d. Gonadal Steroidal treatments (estrogen and progesterone).
Risk factors:
a. Parity.
b. Other uterine diseases such as uterine leiomyomas and endometriosis.
c. Prior uterine surgery.
Possible complications:
a. Preterm birth.
b. Infertility.
c. Anemia in case of heavy prolonged menstrual period.
Evaluation and diagnosis:
a. Patient’s history and current medications.
b. Pelvic examination to check uterus changes (enlarged, soft).
c. Lab tests for:
1. Pregnancy test to exclude pregnancy.
2. Hemoglobin level in case of heavy menstrual period.
d. Transvaginal ultrasound.
e. MRI to differentiate it from leiomyomas.
f. Endometrial biopsy if thickened endometrium.
Differential diagnosis:
Uterine leiomyomas, endometrial polyps, endometriosis .
Treatment:
a. Anti-inflammatory drugs: relieve pain and reduce menstrual bleeding.
b. Hormonal medications for relieving pain and reducing menstrual bleeding:
1. levonorgestrel-releasing IUD
2. Estrogen-progestin contraceptives
3. Oral dienogest
4. GnRH analogs
5. Aromatase inhibitors
c. Uterine artery embolization, can affect pregnancy.
d. Uterus-sparing resection. Rate of uterine rupture is 4% if pregnancy occurs.
e. Ultrasound-guided ablation.
f. Ultrasound or MRI-guided focused ultrasound surgery.
g. Hysterectomy: done by laparotomy, transvaginal or laparoscopy.
