Uterine adenomyosis is the presence of endometrial glands and stroma in the uterine musculature. Symptoms include heavy menstrual bleeding, dysmenorrhea, and pelvic pain. Diagnosis is with a pelvic examination that detects a diffusely enlarged uterus and with transvaginal ultrasonography or MRI. Treatment is hormonal medications or hysterectomy.
In uterine adenomyosis, ectopic endometrial tissue infiltrates the myometrium. This tends to induce diffuse uterine enlargement (globular uterine enlargement). The uterus may double or triple in size but typically does not exceed the size of a uterus at 12 weeks' gestation.
True prevalence is unknown, partly because making the diagnosis is difficult. However, adenomyosis is most often detected incidentally in women who are being evaluated for endometriosis, fibroids, or pelvic pain. Higher parity increases risk.
Symptoms and Signs of Uterine Adenomyosis
Common symptoms of uterine adenomyosis are heavy menstrual bleeding, dysmenorrhea, and anemia. Chronic pelvic pain may also be present.
Symptoms may resolve after menopause.
Diagnosis of Uterine Adenomyosis
Pelvic examination
Usually ultrasonography or MRI
Uterine adenomyosis is suggested by symptoms and diffuse uterine enlargement seen during a pelvic examination in patients without endometriosis or fibroids. Transvaginal ultrasonography and MRI are commonly used for diagnosis, although definitive diagnosis requires histology after hysterectomy.
Treatment of Uterine Adenomyosis
Hysterectomy
The most effective treatment for uterine adenomyosis is hysterectomy.
Hormonal treatments similar to those used to treat endometriosis
Key Points
In uterine adenomyosis, the uterus may double or triple in size.
It commonly causes heavy menstrual bleeding, dysmenorrhea, and anemia and may cause chronic pelvic pain; symptoms may resolve after menopause.
Diagnose by transvaginal ultrasonography and/or MRI; however, definitive diagnosis requires histology after hysterectomy.
The most effective treatment is hysterectomy, but hormonal treatments (eg, oral contraceptives) can be tried.
