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is a medical condition characterized by the presence of ectopic
Endometrial Tissue (the inner lining of the
Uterus ) within the
Myometrium (the thick, muscular layer of the uterus).
The condition is typically found in women in the ages between 35 and 50. Patients with adenomyosis can have painful and/or profuse
Menses (
Dysmenorrhea &
Menorrhagia , respectively).
Adenomyosis may involve the uterus focally, creating an
Adenomyoma , or diffusely. With diffuse involvement, the uterus becomes bulky and heavier.
The cause of adenomyosis is unknown, although it has been associated with any sort of uterine trauma that may break the barrier between the endometrium and myometrium, such as
Cesarean Sections ,
Tubal Ligation ,
Pregnancy Termination , and any
Pregnancy .
Some say that the reason adenomyosis is common in women between the ages of 35 and 50 is because it is between these ages that women have an excess of estrogen. Near the age of 35, women typically cease to create as much natural
Progesterone , which counters the effects of estrogen. After the age of 50, due to menopause, women do not create as much
Estrogen .
The
Uterus may be imaged using
Ultrasound (US) or
Magnetic Resonance Imaging (MR). Transvaginal ultrasound is the most cost effective and most available. Either modality will show an enlarged uterus. On ultrasound, the uterus will have a heterogeneous texture, without the focal well-defined masses that characterize
Uterine Fibroids .
MR provides better diagnostic capability due to the increased spatial and contrast resolution, and to not being limited by the presence of bowel gas or calcified uterine fibroids (as is ultrasound). In particular, MR is better able to differentiate adenomyosis from multiple small
Uterine Fibroids the uterus will have a thickened
Junctional Zone with diminished signal on both T1 and T2 weighted sequences due to succeptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the
Junctional Zone greater than 10 or 12 mm (depending on who you read) is diagnostic of adenomyosis (<8 mm is normal). Interspersed within the thickened, hypointense signal of the junctional zone, one will often see foci of hyperintensity (brightness) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage.
MR can be used to classify adenomyosis based on the depth of penetration of the ectopic endometrium into the myometrium.
Treatment options range from use of
NSAIDS & hormonal suppression for symptomatic relief, to endometrial ablation or
Hysterectomy for a more or less permanent cure.
Those that believe an excess of estrogen is the cause or adenomyosis, or that it aggravates the symptoms, recommend avoiding products with
Xenoestrogen s and/or recommend taking natural progesterone supplements.
The differential of abnormal uterine bleeding includes
In a younger woman, considerations should be broadened to include
There is no increased risk for cancer development. As the condition is estrogen-dependent, menopause presents a natural cure. Patients with adenomyosis often also have
Leiomyoma ta and/or
Endometriosis .
