Adenomyosis

Question 1

What is this?

What’s its prognosis?

Answer 1

➊ Endometrial tissue inside the myometrium – May occur alone, or alongside endometriosis and fibroids

➋ Like endometriosis and fibroids, it tends to resolve after menopause as its symptoms are related to the hormonal cycle

Question 2

How does it present?

How can it present in pregnancy?

What may be found O/E?

Answer 2

➊ • ~1/3 of pts are asymptomatic
• Dysmenorrhoea
• Menorrhagia
• Dyspareunia

➋ Infertility, Miscarriage, Premature birth, Small for gestational age, PROM

➌ Enlarged, tender uterus, but will be softer than Fibroids

Question 3

What is the 1st line investigation to do?

What is the gold standard diagnostic option?

Answer 3

➊ TVUS
• MRI and Transabdominal US are other options

➋ Hysterectomy w/histology

Question 4

How is it managed if the pt doesn’t want contraception?

How is it managed if the pt does want contraption?

Answer 4

➊ Can only provide symptomatic relief
* If pain - Mefenamic acid (NSAID) – reduces pain and bleeding
* If no pain - Tranexamic acid – reduces bleeding

➋ * Mirena coil – 1st line
* COCP
* Cyclical oral progestogens