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Adenomyosis

Adenomyosis is characterized by the presence of endometrial glands and stroma in the myometrium and is often associated with local myometrial hypertrophy. Endometrial glands and stroma outside the uterus, or including the serosa but not the myometrium, are defined as adenomiosis.

Histogenesis and Pathology

The most popular theory of the histogenesis of adenomyosis is that the basoendometrium invades the myometrium to give rise to foci of adenomyosis. Uterine trauma at the time of delivery, increased uterine pressure, or chronic endometritis may contribute to this invasion adenomyosis. Alternatively, preliminary evidence suggests that some lesions may be monoclonal and can exhibit the cytogenetic abnormalities seen in myomata. If adenomyosis proves to be clonal, then it likely arises from a somatic mutation in a precursor cell that causes a dysregulation in

The normal endomyometrial junction is irregular, with endometrial glands and stroma dipping into the myometrium for a variable distance. Many pathologists define adenomyosis as the presence of endometrial glands and stroma in the myometrium more than 2-3 mm below the endomyometrial junction. The pathologic diagnosis of adenomyosis is highly dependent on the number of sections from the uterine specimen that are processed for analysis. In one study of

Symptoms and Signs

The clinical diagnosis of adenomyosis usually is based on the triad of menorrhagia, dysmenorrhea, and a slightly enlarged, "boggy" uterus on physical examination. Most women are between 35 and 50 years of age when the diagnosis is made, and up to 35% of women with adenomyosis are asymptomatic. Recent studies suggest that the

Diagnosis

A major problem with adenomyosis is that the diagnosis can be difficult to make before hysterectomy. As noted above, even after a hysterectomy is performed, the diagnosis of adenomyosis is dependent on the number of myo-metrial sections submitted for analysis. Numerous imaging tests have been used to help in the diagnosis of adenomyosis. Transvaginal sonography has only modest sensitivity and specificity. In one study, transvaginal sonography was noted to have a sensitivity of 86% and a specificity of 50% in the diagnosis of adenomyosis. In a

Treatment

Hysterectomy is the only treatment that clearly is effective in the treatment of adenomyosis. Preliminary studies suggest that hormonal treatments effective in the treatment of myomata also can be used to successfully treat adenomyosis. In a small number of case reports, women with longstanding infertility and adenomyosis were treated successfully with

Many women with infertility and severe adenomyosis have distortion and partial or complete occlusion of the intramural portion of the

Treatment with a GnRH agonist reduces estradiol production and shrinks the adenomyosis lesions, which can result in tubal patency. Once therapy with the GnRH agonist is discontinued, ovulation resumes and the patient may become pregnant prior to the regrowth of the