- synonym: “endometriosis interna” (uterine wall may be diffusely involved)
- Epidemiology
- 15% of females >35 y/o; found in 20-40% of hysterectomy specimens
- mean age at presentation: 40-50 y/o (older age group than seen in endometriosis)
- adenomyosis is a common histologic finding in asymptomatic patients
- Clinical Features
- often asymptomatic
- heavy menstrual bleeding, secondary dysmenorrhea, pelvic discomfort
- dyspareunia, dyschezia
- uterus symmetrically bulky, usually <14 cm
- Halban’s sign: tender, softened uterus on premenstrual bimanual exam
- Investigations
- clinical diagnosis
- U/S or MRI can be helpful
- endometrial sampling to rule out other pathology
- Treatment
- medical
- iron supplements for anemia
- analgesics, NSAIDs
- Mirena® IUS
- CHC, medroxyprogesterone (Depo-Provera®) – limited evidence for efficacy
- GnRH agonists (e.g. leuprolide (Lupron ®))
- danazol 100-200 mg PO once daily (trial x 4 mo)
- surgical
- definitive: hysterectomy – treatment of choice in women who have completed childbearing
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