Adenomyosis

Question 1

Describe what is meant by adenomyosis [1]

Which population of women does it more commonly occur in? [1]

Answer 1

Adenomyosis refers to endometrial tissue inside the myometrium (muscle layer of the uterus).
- It is more common in multiparous women towards the end of their reproductive years.

It occurs in around 10% of women overall

Question 2

Describe the presentation of adenomyosis

Answer 2

• Painful periods (dysmenorrhoea)
• Heavy periods (menorrhagia)
• Pain during intercourse (dyspareunia)
• It may also present with infertility or pregnancy-related complications
• enlarged, boggy uterus
• Around a third of patients are asymptomatic.

Question 3

How does adenomyosis compare to fibroids upon examination? [1]

Answer 3

It will feel more soft than a uterus containing fibroids.

Question 4

First line investigation of adenomyosis? [1]

Management for adenomyosis?:
- Management when contraception is wanted or acceptable [3]
- Management when contraception is not wanted [3]

Answer 4

NICE recommend transvaginal ultrasound as the first-line investigation

Management w contraception:
- First line: Mirena coil
- Second line: Combined oral contraceptive pill
- Third line: Cyclical oral progestogens

Management w/out contraception:
- When theres is no pain: **TXA **
- When theres is pain: Mefenamic acid

NB: 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.