Adenomyosis is defined as a uterine abnormality.
Endometrial glands and stroma are present within the myometrium, which may or may not result in uterine hypertrophy of the muscle fibers or hypertrophy of organs. It is common for patients with adenomyosis to also suffer from leiomyoma or endometriosis. It is more common in women between the age group of 35 to 50 years.
It is probably more common at this age because women have excess estrogen in this period of life. Near 35 years of age, the woman’s body ceases production of progesterone, which leads to a balance of the effects of estrogen. After 50 years of menopause, women do not produce more estrogen.
The cause of this pathology has not been elucidated. However, it may be related to uterine trauma that can rupture the barrier between the endometrium and the myometrium, which can occur during pregnancy, cesarean section, or tubal ligation.
There are two different forms of adenomyosis and can be focal (involving only the uterus) or diffuse. In the beginning, the foci of adenomyosis are observed dispersed in the endometrium. Subsequently, the nodules can be seen in the myometrium and ectopic hypertrophic endometrium.
The symptomatology of adenomyosis is similar to other uterine pathologies: increased menstrual flow (menorrhagia) and uterine cramps (dysmenorrhea), leading to a decrease in patients’ quality of life.
The diagnosis is made by considering the history and physical examination of women in the age group previously described (35 to 50 years) who have had children and have undergone surgery on the myometrium and clinical alterations. The confirmation is done through imaging tests such as ultrasound and magnetic resonance imaging.
Treatment includes the use of non-steroidal anti-inflammatories and through the use of GnRH agonists to reduce symptoms. An endometrial ablation only affects the surface of the endometrial tissue and not the tissue that expands into the uterine muscle. This remaining tissue still causes pain, and surgical removal is the only option for a permanent cure.