Adenomyosis

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