Adenomyosis Flashcards
What is adenomyosis?
Adenomyosis refers to endometrial tissue inside the myometrium (muscle layer of the uterus)
What patients are affected by 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.
Co-morbidities associated with adenomyosis?
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.
How does a patient with adenomyosis present?
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.
What will examination of a patient with adenomyosis reveal?
Examination can demonstrate an enlarged and tender uterus. It will feel more soft than a uterus containing fibroids
How is adenomyosis diagnosed?
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.
How is adenomyosis managed?
NICE recommend the same treatment for adenomyosis as for heavy menstrual bleeding.
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)
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.
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
How does adenomyosis impact pregnancy?
Adenomyosis is associated with:
Infertility Miscarriage Preterm birth Small for gestational age Preterm premature rupture of membranes Malpresentation Need for caesarean section Postpartum haemorrhage
