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Adenomyosis

Definition

Adenomyosis is a thickening of the uterus. It occurs when endometrial tissue, which normally lines the uterus, moves into the outer walls of the uterus.

Alternative Names

Endometriosis interna; Adenomyoma

Causes

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

The disease most often occurs in women ages 40 - 50 who have had at least one pregnancy.

Symptoms

In many cases, the woman may not have any symptoms. When symptoms occur, they can include:

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

Exams and Tests

The health care provider will make the diagnosis if a woman has symptoms of adenomyosis that are not caused by other problems. The only way to confirm the diagnosis is by examining the tissue of the uterus after a hysterectomy.

During a pelvic exam, the doctor may find a 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 get close to menopause. However, only a few will have symptoms. Most women do not need treatment.

Birth control pills and a progesterone-containing intrauterine device (IUD) can help decrease heavy bleeding. Anti-inflammatory medication such as ibuprofen or naproxen can also help manage symptoms.

A hysterectomy may be necessary in women with severe symptoms.

Outlook (Prognosis)

Symptoms most often go away after menopause. A hysterectomy completely relieves symptoms.

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of adenomyosis.

References

Katz VL. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 18.

Meredith SM, Sanchez-Ramos L, Kaunitz AM. Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and meta analysis. Am J Obstet Gynecol. 2009;201:107.e1-6.


Review Date: 7/28/2014
Reviewed By: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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