OSH STATE UNIVERSITY

INTERNATIONAL MEDICAL FACULTY

 Topic-Adenomyosis
Faculty-Gynecology
Guided By:-ABDIRASULOVA MAM
Submitted By:-Pooja Shriwas
Group:-3B (5th Year)
 DEFENITION
• Benign ingrowing of endometrium into the
myometrium
• Both glandular and stromal components of
endometrium are involved
• Etiology unknown
 PATHOLOGY
• Uterus enlarged(myometrial hyperplasia)
• Asymmetrical enlargement, more on
posterior wall
• Size not more than 12-14 weeks of a gravid
uterus
• Cut section: thickening of uterine wall-
characteristic trabeculated appearance
• No capsule
Gross photograph of uterus showing thickened
endometrium (hyperplasia) with trabeculated
appearance of myometrium (adenomyosis)
• Microscopy-glandular tissue surrounded
by stromal cells in the myometrium
• Ectopic endometrium -separate from the
underlying basal endometrium, located
deeper than the endomyometrial junction
by more than one HPF
• Response to steroids minimal- invasion
mainly in the basal layer
 CLINICAL FEATURES

• Usually asymptomatic, detected on routine

examination
• Usually parous , in their forties
• Can coexist with endometriosis and
fibroids
SYMPTOMS
• Menorrhagia(increased surface area &
endometrial hyperplasia) or
menometrorrhagia
• Congestive dysmenorrhea( cramping starts
with the menstrual flow or days earlier)
• Some can have cramps throughout the month
aggravating during the periods
• Deep dyspareunia premenstrually
SIGNS
• Abdominal examination- uterus enlarged(
not more than 14 weeks)
• Pelvic examination- uniform uterine
enlargement with no restriction of mobility
• Uterus may be softer than normal
• Findings altered if there is associated
endometriosis
 ULTRASOUND
• Enlarged uterus –asymmetrical enlargement
of usually the posterior wall
• Myometrium – multiple small cysts,
increased vascularity, heterogeneous
texture
• Endomyometrial junction indistinct
• If localised, misdiagnosed for fibroids
 MRI
• Widening of junctional zone- thickness
12mm or more
• Differentiate localised adenomyoma and
fibroid- lack distinct borders and usually
posterior
 MANAGEMENT
• Depends on age and desire for future fertility
• Secondary dysmenorrhea- NSAIDS & OCPs
• GnRH agonists, LNG-IUS
• Medical management- not very effective
• Total hysterectomy (parous women >40)
• Resection (younger women, localised
adenomyosis)
THANK YOU