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Adenomyosis

Adenomyosis is where there's growth of endometrial tissue inside the myometrium – May occur alone, or alongside endometriosis and fibroids. Like endometriosis and fibroids, it tends to resolve after menopause as its symptoms are also related to the hormonal cycle.


Presentation

  • ~1/3 of pts are asymptomatic

  • Dysmenorrhoea

  • Menorrhagia

  • Dyspareunia

  • Infertility

  • In pregnancy, it can present with Premature birth, Small for gestational age, PROM


O/E - May fine an enlarged, tender uterus, but will be softer than Fibroids.


Investigations

TVUS - 1st line

  • MRI and Transabdominal US are other options


Hysterectomy w/histology is the gold standard diagnostic option.

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Adenomyosis uteri (endometriosis of the uterine wall) - Hic et nunc (https://commons.wikimedia.org/wiki/File:Adenomyosis.jpg) “Transvaginal ultrasonography of the uterus, showing the endometrium as a hyperechoic (brighter) area in the middle, with linear striations extending upwards from it. This is a specific sign of adenomyosis.” © Mikael Häggström CC0 1.0 (https://commons.wikimedia.org/wiki/File:Linear_striations_of_adenomyosis.jpg)

Management

If the patient doesn’t want contraception, they can only be given symptomatic relief

  • If pain - Mefenamic acid (NSAID) – reduces pain and bleeding

  • If no pain - Tranexamic acid – reduces bleeding


If the patient does want contraception, they can be given:

  • Mirena coil – 1st line

  • COCP

  • Cyclical oral progestogens




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