Adenomyosis

Question 1

risk factors?

Answer 1

• older age
• multiparous women

Question 2

describe it

Answer 2

• may occur alone or alongside fibroids / endometriosis
• hormone-dependent

Question 3

presentation?

Answer 3

• may be asymptomatic
• dysmenorrhoea
• menorrhagia
• dyspareunia
• infertility / pregnancy related complications

Question 4

O/E?

Answer 4

enalarged, tender uterus that feels more soft than a uterus containing fibroids

Question 5

Ix?

Answer 5

1. TVUS
   
   • MRI if not available

• gold standard- histological examination of myometrium post hysterectomy

Question 6

Mx?

Answer 6

Medical

• non-hormonal
  
  • tranexamic acid / mefenamic acid
• hormonal
  
  • mirena coil
  • COCP
  • cyclical oral progestogens
  • progesterone-only medications
• GnRH agonists

Surgical

• UAE
• hysterectomy
• endometrial ablation

Question 7

what is adenomyosis associated with?

Answer 7

pregnancy complications…

• infertility
• miscarriage
• preterm birth
• small for gestational age
• PPROM
• malpresentation
• c section
• PPH