Adenomyosis

Definitions

Benign invasion of endometrium (glands and stroma) in to the myometrium with adjacent smooth muscle hyperplasia.

Types

Diffuse

Localized (adenomyoma)

Symptoms

HMB

2ndary dysmenorrhea

Rare in nulliparous and less frequent in smokers

Common age of presentation 45

Risk factors

Age

Previous uterine surgeries – LSCS ,myomectomy, ERPC etc

Signs

Enlarged tender uterus

Symmetrical enlargement if adenomyosis is diffuse

Asymmetrical enlargement in localzed adeomyosis

Associated conditions

Upto 80% of adenomyosis  are associated with fibroid ,endometrial hyperplasia ,peritoneal endometriosis,uterine cancer ,salphingitis isthemica nodosum (SIN)

Investigation

TVS

MRI

Accurate diagnosis is made only after histological examination of specimen after surgery.

FBC to assess anemia

Treatment

Medical

Non hormonal- NSIADS reduces pain and flow

Hormonal – progestegens

                      OCP

                      GnRH agonist

                      Levenogestrol containiong IUCD – Mirena

Surgical

Hysterectomy

If adenomyosis is localized and fertility requirement is there , resection of adenomyoma can be attempted. Risk – uterinr rupture in next pregnancy.