Adenomyosis Flashcards
Definition
Endometrial tissue inside of the myometrium (muscle layer of the uterus)
- More common in later reproductive years and those who have had several pregnancies (multiparous)
- It may occur alone or alongside endometriosis or fibroids.
Pathophysiology
The condition is hormone-dependant, and symptoms tend to resolve after menopause, similarly to endometriosis and fibroids
Signs and symptoms
- Painful periods (dysmenorrhoea)
- Heavy periods (menorrhagia)
- Pain during intercourse (dyspareunia)
- May also present with infertility or pregnancy related complications
- 1/3 = Asx
Examination demonstrates
Enlarged tender uterus
- it will feel more soft than a uterus containing fibroids
Diagnosis
- FIRST LINE = transvaginal USS
- MRI + transabdominal USS = alternatives where FL not suitable
GOLD STANDARD = Histological examination of the uterus after a hysterectomy. However this is not a suitable way of establishing diagnosis obviously….
Treatment
Dependant on symptoms, age, and plans for pregnancy.
Treatment when woman does NOT want contraception
Treatment can be used during menstruation for symptomatic relief:
- Tranexamic acid when there is no associated pain (antifibrinolytic – reduces bleeding)
- Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)
Treatment when contraception is wanted
- FIRST LINE = Mirena coil
- COCP
- Cyclical oral progestogens
Progesterone only medications such as the pill, implant or depot injection may also be helpful
Other options to considered by a specialist
- GnRH analogues to induce a menopause-like state
- Endometrial ablation
- Uterine artery embolisation
- Hysterectomy
Pregnancy and adenomyosis associations
- Infertility
- Miscarriage
- Preterm birth
- Small for gestational age
- Preterm premature rupture of membranes
- Malpresentation
- Need for caesarean section
- Postpartum haemorrhage
