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Adenomyosis is a benign uterine disease in which endometrial glands and stroma are found within the myometrium. This invasion by the endometrium induces hypertrophy and hyperplasia of the myometrium and produces a diffusely enlarged adenomiosis.

Incidence and etiology

The diagnosis of adenomiosis can be made only by microscopic examination of a specimen obtained at hysterectomy. For this reason, the exact incidence is not known. It is generally estimated that 20% of women have adenomiosis. However, careful analysis of multiple myometrial sections may reveal an incidence as

Adenomyosis is associated with childbearing. It is estimated that at least 80% of women with this disorder are parous. However, the incidence of adenomyosis is not correlated with increasing parity. Adenomyosis most commonly produces symptoms in adenomiosis. 

Although the exact cause is unknown, the most widely accepted theory of histogenesis was proposed by Meyer in 1900. Meyer postulated that the normal barrier between the endometrium and myometrium, which prevents intrusion of endometrial glands and stroma, is somehow attenuated. After alteration of this barrier, the myometrium is invaded.

More than 80% of women with adenomyosis have another pathologic process in the uterus; 50% of patients have associated leiomyomas, approximately 11% have endometriosis, and 7% have endometrial polyps. The symptoms of the associated condition often obscure the diagnosis of adenomiosis.


The typical uterus with adenomiosis is boggy and uniformly enlarged. Approximately 80% of uteri with adenomyosis weigh more than 80 gm, but it is unusual for a uterus with adenomyosis.


As mentioned earlier, adenomyosis most commonly produces symptoms in women between the ages of 40 and 50 years. Approximately 60% of women experience abnormal uterine bleeding, 50% develop hypermenorrhea, and 25% manifest metrorrhagia.

Dysmenorrhea is the second most frequent symptom in patients with adenomyosis, occurring in 25% of cases. Dysmenorrhea is correlated with deep penetration and with a high density of endometrial elements.


A review of the literature demonstrates that only 15% of cases of adenomyosis are correctly diagnosed preoperatively. The reasons for this low percentage are two-fold: (1) many if not most patients.

D&C does not aid in diagnosis. Pelvic ultrasonography may be suggestive.


The only definitive treatment for adenomyosis is total hysterectomy, with or without ovarian conservation. Synthetic progestins are not helpful and may actually increase the level of pelvic pain.

GnRH agonists have been used in a few cases, resulting in a transient decrease in uterine size, in amenorrhea.

Unfortunately, regrowth of the uterus.