Adenomyosis 

A condition where the endometrial glands [lining of the womb] are present in the myometrium [muscle layer of the womb] of the uterus.  It is a benign condition but the symptoms may have a negative impact on a woman’s quality of life.  It may present in 10% of women.  It may affect the whole of the uterus [adenomyosis] or part of the uterus [adenomyoma].  Diagnosis is made by histology when the uterus is removed.

Symptoms

  • Menorrhagia [heavy periods]
  • Dysmenorrhoea [painful periods]
  • Dyspareunia [pain during and after sex]
  • Pelvic pain
  • Anaemia

Investigations

Pelvic ultrasound scan or MRI which may show a loss of definition between the endometrium and myometrium, localized thickened uterine wall and an enlarged uterus.

Laparoscopy may reveal enlarged, soft and doughy uterus as seen in this picture.

 

 

Treatments

Depending on patient’s desire to retain uterus for fertility and whether the disease affects the whole of the uterus or only part of the uterus.  If patient wishes to retain uterus for pregnancy then medical treatment is the only option available which may not confer complete symptomatic relief.  However the effect of medical treatment is temporary when the medication is discontinued, the symptoms return.   If fertility is no longer desired then hysterectomy may be the only cure by removing the pathology.  It may be possible to resect the adenomyoma to provide symptomatic relief.