Adenomyosis

Functioning endometrium has penetrated myometrium by direct spread

Pathology

• endometrial glands and stroma found deep within myometrium

• relatively insensitive to hormones

• small, little blood

• intense stromal reaction

History

• later in reproductive years as takes time to develop

• 1/3 patients asymptomatic

• progressively increasing pain, peaking towards latter end of menstruation

• menorrhagia

• intermenstrual bleeding

• bladder and rectal pressure

Examination

• uterus

  • tender

  • enlarged

  • globular

  • softer than normal

Investigation

• MRI

Management

• Contraceptive steroids and GnRH agonists are not very effective

• discrete adenomyomata

• may need no treatment

• hysterectomy if symptoms severe