Adenomyosis

Question 1

What is adenomyosis?

Answer 1

Presence of endometrial tissue in the myometrium

Question 2

Describe the aetiology of adenomyosis

Answer 2

More common during later reproductive years
More common in multiparous women
Occurs in 10% of women

Question 3

How does adenomyosis usually present?

Answer 3

• Painful periods (dysmenorrhoea)
• Heavy periods (menorrhagia)
• Pain during intercourse (dyspareunia)
• Pregnancy related complications
• Infertility

Question 4

What will examination show in adenomyosis?

Answer 4

Possible enlarged and tender uterus

Question 5

What are some tests required in adenomyosis?

Answer 5

Trans-vaginal US (1st line)
MRI or trans-abdominal US if TVUS not suitable
Histological examination after hysterectomy (Gold standard)

Question 6

What are some pregnancy complications in adenomyosis?

Answer 6

• Infertility
• Miscarriage
• Preterm birth
• Small for gestational age
• Preterm premature rupture of membranes
• Malpresentation
• Need for caesarean section
• Postpartum haemorrhage

Question 7

What are some management options for adenomyosis in those who DO NOT want contraception

Answer 7

Tranexamic acid - When no pain (Antifibrinolytic)
Mefenamic acid - When there is pain (NSAID)

Question 8

What are some management options for adenomyosis in those who DO want contraception

Answer 8

1. Mirena coil (first line)
2. Combined oral contraceptive pill
3. Cyclical oral progestogens

Question 9

What are some surgical management options for adenomyosis?

Answer 9

• Endometrial ablation
• Uterine artery embolisation
• Hysterectomy