Adenomyosis is the term used to describe endometriosis in the muscle of the womb.

Incidence

• Adenomyosis is found in about 10% of hysterectomy specimens and is probably present in about 5% of women of fertile age.

Age

• The onset of adenomyosis is usually at about aged 35.
• It usually presents after childbirth.

Geographic

• Diagnosis is more commonly made in Western women.

Clinical features

• Symptoms that women have include;
  • Dysmenorrhoea (pelvic pain during or around menstruation). Classically, this is worse during the first few days of menstruation and a few days before the onset.
  • Dyspareunia. Painful intercourse can also occur in adenomyosis.
  • Menorrhagia. Women with adenomyosis are more likely to complain heavy periods.
• Clinical signs are not pathognomonic as there are many differentials in the diagnosis of pelvic pain (causes boxE1). However, certain signs may aid diagnosis;
  • Abdominal tenderness. Many women have lower abdominal tenderness on abdominal examination. This is predominantly suprapubic and worse just before and during menstruation.
  • Uterine tenderness. On vaginal examination, the uterus may be tender.
• Adenomyosis is diagnosed at hysterectomy. However, other radiological tests can be useful in making the dagnosis;
  • Ultrasound. This can often identify soft features of adenomyosis.
  • MRI. MRI can identify certain features such as a the loss of something called the junctional zone.

Management

• All medical treatments suppress ovulation and are unsuitable for women wishing to conceive.

• All medical treatments for endometriosis are suitable for adenomyosis.

• The mirena intrauterine system can be very effective treatment for adenomyosis.

• Surgical treatment usually involves hysterectomy.

Prognosis

• Adenomyosis is a self-limiting condition that resolves during the menopause.