Adenomyosis 1481453 225144284 2008-07-12T03:05:45Z Arcadian 104523 mesh {{Unreferenced|date=May 2008}} {{DiseaseDisorder infobox | Name = Adenomyosis | ICD10 = {{ICD10|N|80|0|n|80}} | ICD9 = {{ICD9|617.0}} | ICDO = | Image = | Caption = | OMIM = 600458 | MedlinePlus = 001513 | eMedicineSubj = radio | eMedicineTopic = 737 | DiseasesDB = 250 | MeshID = D004715 | }} '''Adenomyosis''' is a medical condition characterized by the presence of ectopic [[endometrium|endometrial tissue]] (the inner lining of the [[uterus]]) within the [[uterus|myometrium]] (the thick, muscular layer of the uterus). The condition is typically found in women between the ages of 35 and 50. Patients with adenomyosis can have painful and/or profuse [[menses]] ([[dysmenorrhea]] & [[menorrhagia]], respectively). Adenomyosis may involve the uterus focally, creating an [[adenomyoma]], or diffusely. With diffuse involvement, the uterus becomes bulky and heavier. ==Causes== The cause of adenomyosis is unknown, although it has been associated with any sort of uterine trauma that may break the barrier between the endometrium and myometrium, such as a [[caesarean section]], [[tubal ligation]], [[pregnancy termination]], and any [[pregnancy]]. Some say that the reason adenomyosis is common in women between the ages of 35 and 50 is because it is between these ages that women have an excess of estrogen. Near the age of 35, women typically cease to create as much natural [[progesterone]], which counters the effects of estrogen. After the age of 50, due to menopause, women do not create as much [[estrogen]]. ==Diagnosis== The [[uterus]] may be imaged using [[ultrasound]] (US) or [[magnetic resonance imaging]] (MRI). Transvaginal ultrasound is the most cost effective and most available. Either modality will show an enlarged uterus. On ultrasound, the uterus will have a heterogeneous texture, without the focal well-defined masses that characterize [[leiomyoma|uterine fibroids]]. MRI provides better diagnostic capability due to the increased spatial and contrast resolution, and to not being limited by the presence of bowel gas or calcified uterine fibroids (as is ultrasound). In particular, MR is better able to differentiate adenomyosis from multiple small [[leiomyoma|uterine fibroids]]. The uterus will have a thickened [[uterus|junctional zone]] with diminished signal on both T1 and T2 weighted sequences due to susceptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the [[uterus|junctional zone]] greater than 10 to 12 mm (depending on who you read) is diagnostic of adenomyosis (<8 mm is normal). Interspersed within the thickened, hypointense signal of the junctional zone, one will often see foci of hyperintensity (brightness) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage. MR can be used to classify adenomyosis based on the depth of penetration of the ectopic endometrium into the myometrium. ==Treatment== Treatment options range from use of [[NSAIDS]] & hormonal suppression for symptomatic relief, with [[hysterectomy]] the only permanent cure option. Women with Adenomyosis fail [[endometrial ablation]] because the ablation only affects the surface endometrial tissue, not the tissue that has grown into the muscle lining. This remaining tissue is still viable and will continue to cause pain. The result of failed ablation due to Adenomyosis is hysterectomy. Those that believe an excess of estrogen is the cause or adenomyosis, or that it aggravates the symptoms, recommend avoiding products with [[xenoestrogen]]s and/or recommend taking natural progesterone supplements. ==Other considerations== The differential of abnormal uterine bleeding includes *endometrial [[polyps]] *submucosal [[leiomyoma|fibroids]] *[[endometrial hyperplasia]] *[[endometrial carcinoma]] In a younger woman, considerations should be broadened to include *[[spontaneous abortion]] *[[ectopic pregnancy]] ==Prognosis== There is no increased risk for cancer development. As the condition is estrogen-dependent, menopause presents a natural cure. Patients with adenomyosis often also have [[leiomyoma]]ta and/or [[endometriosis]]. ==External links== * {{GPnotebook|-2066743296}} {{Diseases of the pelvis, genitals and breasts}} [[Category:Diseases]] [[es:Adenomiosis]] [[hr:Adenomioza]] [[nl:Adenomyose]] [[he:אדנומיוזיס]] [[pt:Adenomiose]]