7. Adenomyodis Flashcards
What is adenomyosis?
Adenomyosis is a benign condition where the endometrium invades the myometrium, leading to a diffusely enlarged and tender uterus. Microscopically, it features ectopic, non-neoplastic endometrial glands and stroma surrounded by hypertrophic and hyperplastic myometrium.
Who is typically affected by adenomyosis?
Adenomyosis was traditionally thought to affect older parous women, but there are now increasing cases in younger women. The condition has an incidence rate ranging from 5-20%, although the exact figure is unknown.
Is adenomyosis associated with any other conditions?
Yes, adenomyosis is often associated with fibroids.
What is the pathophysiology of adenomyosis?
The exact cause is unknown, but adenomyosis is thought to result from tissue injury and repair due to excessive myometrial forces. This leads to the invasion of the endometrium into the myometrium.
What are the common symptoms of adenomyosis?
Common symptoms of adenomyosis include heavy menstrual bleeding (seen in 50-60% of patients), dysmenorrhoea, constant dull aching pain, and infertility (though infertility is less common as many women with adenomyosis are parous).
What signs might suggest adenomyosis?
Signs depend on any coexisting conditions, but typically include a tender, bulky uterus. The uterus may also be enlarged if fibroids are present. Historically, the diagnosis was only confirmed postoperatively after histological review of the uterus.
What diagnostic methods are used for adenomyosis?
Newer diagnostic methods include ultrasound scanning and magnetic resonance imaging (MRI), both of which have high sensitivity and specificity for diagnosing adenomyosis.
What are the main treatments for adenomyosis?
Treatment options include:
• Analgesia for pain relief.
• Contraceptives such as combined oral contraceptives, injectable contraceptives, or the Mirena intrauterine system (IUS) to help manage symptoms.
• Surgery, including hysterectomy if the family is complete.
Are there any newer conservative treatments for adenomyosis?
Newer conservative treatments include:
• Danazol-loaded intrauterine system (still in research studies, not available in South Africa).
• Magnetic Resonance Focused Ultrasound (MRgFUS), which uses focused ultrasound to target specific areas, raising the temperature and causing irreversible cell damage to reduce symptoms.