Adenomyosis

Adenomyosis

DiseaseDisorder infobox
Name = Adenomyosis
ICD10 = ICD10|N|80|0|n|80
ICD9 = ICD9|617.0
ICDO =


Caption =
OMIM = 600458
MedlinePlus = 001513
eMedicineSubj = radio
eMedicineTopic = 737
DiseasesDB = 250
MeshID = D004715

Adenomyosis 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 between the ages of 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.

Causes

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 a caesarean section, 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.

Diagnosis

The uterus may be imaged using ultrasound (US) or magnetic resonance imaging (MRI). 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.

MRI 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 susceptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the junctional zone greater than 10 to 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

Treatment options range from use of NSAIDS & hormonal suppression for symptomatic relief, with hysterectomy the only permanent cure option. Women with Adenomyosis fail endometrial ablation because the ablation only affects the surface endometrial tissue, not the tissue that has grown into the muscle lining. This remaining tissue is still viable and will continue to cause pain. The result of failed ablation due to Adenomyosis is hysterectomy.

Those that believe an excess of estrogen is the cause or adenomyosis, or that it aggravates the symptoms, recommend avoiding products with xenoestrogens and/or recommend taking natural progesterone supplements.

Other considerations

The differential of abnormal uterine bleeding includes
*endometrial polyps
*submucosal fibroids
*endometrial hyperplasia
*endometrial carcinoma

In a younger woman, considerations should be broadened to include
*spontaneous abortion
*ectopic pregnancy

Prognosis

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 leiomyomata and/or endometriosis.

External links

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Look at other dictionaries:

  • Adenomyosis — Pronounced a den o mi o sis, this is a common benign condition of the uterus in which the endometrium (the mucous membrane lining the inside of the uterus) grows into the myometrium (the uterine musculature located just outside the endometrium).… …   Medical dictionary

  • Adenomyosis uteri — Also known more succinctly as adenomyosis (pronounced ad den o mi o sis), this is a common benign condition of the uterus in which the endometrium (the mucous membrane lining the inside of the uterus) grows into the myometrium (the uterine… …   Medical dictionary

  • adenomyosis — ad·e·no·my·o·sis (ăd n ō mī ōʹsĭs) n. A form of endometriosis characterized by the invasive, usually benign growth of tissue into smooth muscle such as the uterus. * * * …   Universalium

  • adenomyosis — noun A condition characterised by the presence of endometrial tissue in the myometrium, sometimes considered as a form of endometriosis …   Wiktionary

  • adenomyosis — ad·e·no·my·o·sis …   English syllables

  • adenomyosis — n.; see endometriosis …   The new mediacal dictionary

  • adenomyosis — noun the presence of endometrium elsewhere than in the lining of the uterus; causes premenstrual pain and dysmenorrhea • Syn: ↑endometriosis • Hypernyms: ↑pathology …   Useful english dictionary

  • adenomyosis externa — endometriosis …   Medical dictionary

  • adenomyosis tubae — the growth of the endometrium into the lumen of the uterine tube from the uterus, replacing the endosalpinx …   Medical dictionary

  • Аденомиоз (Adenomyosis) — см. Эндометриоз. Источник: Медицинский словарь …   Медицинские термины

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