Adenomyosis Flashcards
What is adenomyosis?
Adenomyosis refers to endometrial tissue inside the myometrium (muscle layer of the uterus).
How common is adenomyosis?
It is more common in later reproductive years and those that have had several pregnancies (multiparous). It occurs in around 10% of women overall. It may occur alone, or alongside endometriosis or fibroids.
What causes adenomyosis?
The cause is not fully understood, and multiple factors are involved, including sex hormones, trauma and inflammation. The condition is hormone-dependent, and symptoms tend to resolve after menopause, similarly to endometriosis and fibroids.
What are the clinical features of adenomyosis?
Adenomyosis typically presents with:
- Painful periods (dysmenorrhoea)
- Heavy periods (menorrhagia)
- Pain during intercourse (dyspareunia)
It may also present with infertility or pregnancy-related complications. Around a third of patients are asymptomatic.
How does adenomyosis present on examination?
Examination can demonstrate an enlarged and tender uterus. It will feel more soft than a uterus containing fibroids.
Briefly describe the diagnosis of adenomyosis
Transvaginal ultrasound of the pelvis is the first-line investigation for suspected adenomyosis.
MRI and transabdominal ultrasound are alternative investigations where transvaginal ultrasound is not suitable.
The gold standard is to perform a histological examination of the uterus after a hysterectomy. However, this is not usually a suitable way of establishing the diagnosis for obvious reasons.
What non-contraceptive management can be offered for adenomyosis?
When the woman does not want contraception; treatment can be used during menstruation for symptomatic relief, with:
- Tranexamic acid when there is no associated pain (antifibrinolytic – reduces bleeding)
- Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)
What contraceptive management can be offered for adenomyosis?
Management when contraception is wanted or acceptable:
- Mirena coil (first line)
- Combined oral contraceptive pill
- Cyclical oral progestogens
Progesterone only medications such as the pill, implant or depot injection may also be helpful.
What specialist management can be offered for adenomyosis?
Other options are that may be considered by a specialist include:
- GnRH analogues to induce a menopause-like state
- Endometrial ablation
- Uterine artery embolisation
- Hysterectomy
What are the complications of adenomyosis?
Adenomyosis is associated with:
- Infertility
- Miscarriage
- Preterm birth
- Small for gestational age
- Preterm premature rupture of membranes
- Malpresentation
- Need for caesarean section
- Postpartum haemorrhage
