Adenomyosis Flashcards
What is adenomyosis?
It refers to the presence of endometrial tissue within the myometrium of the uterus
What three hormones are adenomyosis sensitive to?
Oestrogen
Progesterone
Androgens - including testosterone
What is adenomyosis is a subtype of?
Endometriosis
What is the underlying cause of adenomyosis?
It is thought to occur when the endometrial stroma communicates with the underlying myometrium after uterine damage
What are the four risk factors of adenomyosis?
Perimenopause
Multiparity
Uterine Surgery
C-Section
What are the four clinical features of adenomyosis?
Heavy Menstrual Bleeding
Dysmenorrhoea
Deep Dyspareunia
Subfertility
What are the four investigations used to diagnose adenomyosis?
Pelvic Examination
Ultrasound Scan
MRI Scan
Hysterectomy
What are the two pelvic exam features of adenomyosis?
A symmetrically enlarged, boggy uterus
A tender uterus
What uterus feels softer - fibroid or adenomyosis?
Adenomyosis
What is the first line investigation for adenomyosis?
US scan
What are the five clinical features of adenomyosis on an US?
Globular uterine configuration
Poor definition of the endometrial-myometrial interface
Myometrial anterior-posterior asymmetry
Intramyometrial cysts
Heterogeneous myometrial echo texture
When is an MRI scan used to diagnose adenomyosis?
It can be used as an alternative investigation when transvaginal ultrasound is not suitable
What is the sign of adenomyosis on MRI scan?
An irregular thickening of the endo-myometrial junctional zone
What investigation is used to achieve a definitive diagnosis of adenomyosis?
Hysterectomy
What are the three pharmacological treatments for adenomyosis?
NSAIDs
Contraceptive Management
GnRH Analogues
How are NSAIDs used to treat adenomyosis?
Symptomatic pain relief
What is the first line treatment option used to treat adenomyosis?
NSAIDs
What are the four contraceptive managements used to treat adenomyosis?
Combined oral contraceptive pill
Progesterone-only pill
Intrauterine devices
Progesterone-only injection
How are contraceptives used to treat adenomyosis?
They are used to suppress ovulation and reduce endometrial thickening, causing atrophy of the adenomyosis lesions and a reduction in symptoms
When are contraceptives used to treat adenomyosis?
This management option can be trialled before a definitive diagnosis is established with laparoscopy
What two contraceptives are seen to temporarily induce the regression of adenomyosis?
Combined oral contraception
High dose progesterone-only injections
How are GnRH analogues used to treat adenomyosis?
They induce a menopause-like state in which ovulation is supressed and oestrogen levels are reduced
They therefore cause atrophy of the adenomyosis lesions and a reduction in symptoms
What are the two common GnRH analogues used to treat adenomyosis?
Zoladex
Prostap
What are the three surgical treatments used for adenomyosis?
Laparoscopy
Uterine Artery Embolisation
Hysterectomy
How is laparoscopy used to treat adenomyosis?
It can be used to excise or ablate the adenomyosis tissue to completely remove the ectopic endometrial tissue and adhesions
What is the disadvantage of laparoscopy treatment for adenomyosis?
This treatment option will definitely result in relapses and therefore surgery may have to be repeated
What is uterine artery embolisation? How is it used to treat adenomyosis?
It involves the insertion of a catheter into an artery, usually the femoral artery
This catheter is passed through to the uterine artery under x-ray guidance
Once in the correct place, particles are injected that cause a blockage in the arterial supply to the adenomyosis lesions
This starves the lesions from oxygen and causes it to shrink
When is uterine artery embolisation used to treat adenomyosis?
This is used as an alternative treatment option in the short term for women who wish to avoid hysterectomy or preserve their fertility
What is hysterectomy?
It involves removal of the uterus
What is the definitive treatment option for adenomyosis?
Hysterectomy
