Adenomyosis

Definition

Adenomyosis is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, moves into the outer muscular walls of the uterus.

Alternative Names

Endometriosis interna; Adenomyoma

Causes, incidence, and risk factors

The cause is unknown. Sometimes adenomyosis may cause a mass or growth within the uterus, which is called an adenomyoma.

The disease usually occurs in women older than 30 who have had children. It is more likely in women with previous cesarean section or other uterine surgery.

Symptoms

• Long-term or heavy menstrual bleeding
• Painful menstruation , which gets increasing worse
• Pelvic pain during intercourse

Note: In many cases, the woman may not have any symptoms.

Signs and tests

During a pelvic exam, the doctor may find an soft and slightly enlarged uterus. The exam may also reveal a uterine mass or uterine tenderness.

An ultrasound of the uterus may help tell the difference between adenomyosis and other uterine tumors. MRI can be helpful when ultrasound does not give definite results.

Treatment

Most women have some adenomyosis as they near menopause but few women have symptoms, and most women don’t require any treatment.

In some cases, pain medicine may be needed. Birth control pills and a progesterone-containing intrauterine device (IUD) can help decrease heavy bleeding.

A hysterectomy may be necessary in younger women with severe symptoms.

Expectations (prognosis)

Symptoms usually go away after menopause. A hysterectomy completely relieves symptoms.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of adenomyosis.

References

Katz VL. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 18.

Speroff L, Fritz MA. Dysfunction uterine bleeding. In. Speroff L, Fritz MA, eds. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2005:chap 15.