AUB Flashcards
What percentage of HMB is caused by adenomyosis?
10%
Of which 30% have HMB and dysmenorrhea
Definition of Adenomyosis?
Benign invasion of endometrial glands and stroma in the myometrium.
Surrounded by hypertrophic and hyperplastic myometrium.
How is it diagnosed/investigated?
Definitive diagnosis made on histology, when there is glandular invasion >2.5mm below the EMI(endometrial-myometrial interface).
Usu noted on a hysterectomy specimen.
U/S not the best modality to evaluate with sensitivity of 53-85% and specificity of 50-99%, depending on how experienced the sonographer is.
- HOWEVER it remains first line due to easy accessibility, cost
- presence of uterine fubroids makes u/s diagnosis less predictive.
- Features on u/s:
- enlarged, regular, globular uterus
with no fibroids (diffuse adeno)
- asymmetrical enlargement of the
anterior/posterior uterine walls
- Heterogenous echo texture - the
homogeneity of the
myometrium is lost due to the
areas of adenomysosis.
This is the MOST predictive for
adenomyosis.
- Cystic anechoic lakes of varying
sizes in myometrium
- subendometrial echogenic linear
striations - caused by invasive of endometrium into subendometrial layer.
MRI - higher diagnostic capability regardless of presence/absence of fibroids.
- sensitivity/specificity of 85%
- cons: Expensive, not readily available which affects routine use.
Hysteroscopy - not an accurate diagnostic method.
Features seen include:
1.Irregular endometrium
2.Pitting endometrial defects
3.Altered endometrial vascularity
4.Cystic endometrium with haemorrhagic lesions
How do you manage a patient with adenomyosis?
Depends on fertility desires.
If completed child bearing, then definitive management is hysterectomy.
However management options can be using medical, surgical and interventional radiology.
Medical management may be hormonal or nonhormonal.
Nonhormonal includes nsaids such as mefenamic acid and antifibrinolytics like tranexamic acid. When used together they provide significant improvement of HMB and also dysmenorrhea.
First choice hormonal is GnRHa as they cause amenorrhea, however they are limited by their side effects and cost.
COCPs can also be used with the added benefit of providing contraception.
LNG-IUS may be used to improve pain and hmb
