Adenomyosis

In gynecology, Adenomyosis is the presence of endometrial tissue, the outermost layer of the uterus including the glands, which has moved into the myometrium, the muscle layer of the uterus, causing uterine thickening. Adenomyosis is a benign disorder is common in women who gave birth between the ages of 35 and 50 years of age.2 is capable of producing painful menstruation (dysmenorrhea) or heavy (menorrhagia).

Causes

The cause of adenomyosis is unknown, 1 although it has been associated with a variety of traumas that can eventually break the barrier between the endometrium and myometrium, including cesarean section, tubal ligation, abortion or pregnancy either.

It has been suggested that the reason adenomyosis is more common in women between 35 and 50 years of age is in excess of estrogen in women of that age. Upon reaching the age of 35 years of age, women typically cease to create the same amount of progesterone, a hormone that opposes the anabolic actions of estrogen. Over the 50 years of age due to the onset of menopause, women stop producing as much estrogen.

Classification

Adenomyosis can occur in two ways, taking into account the number of invaded tissue:

  • Diffuse adenomyosis, in which much or all of the uterus is affected.
  • Focal adenomyosis, also called adenomyoma, and is a localized mass within the myometrium.

Diagnosis

The uterus can be visualized and its constituent layers, with an ultrasound or magnetic resonance imaging (MRI) . The transvaginal ultrasound is more effective and more available compared to MRI. Any diagnostic method can show whether the uterus is enlarged. In ultrasound uterine texture will be so heterogeneous without well-defined focal masses that characterize other disorders such as fibroids.

MRI provides better diagnostic ability because of better resolution and contrast in images, especially in the differentiation between adenomyosis and myoma fibrotic. MRI can also detect the depth of penetration of the myometrium. It is generally appreciated diminished signal (hypointense) in the endometrial cavity, especially in T2, 2 demonstrating thickening in question because of the greater amount of iron in the muscle layer of blood from the reservoir characteristic of the endometrium. A thickness of the uterus more than 10 or 12 mm is diagnostic reading of adenomyosis, the normal thickness is 8 mm.

Differential Diagnosis

Other reasons for dysfunctional uterine bleeding include:

  • endometrial polyps
  • submucosal fibroid
  • endometrial hyperplasia
  • endometrial cancer

In young women, diagnostic considerations should be broadened to include:

  • spontaneous abortion
  • ectopic pregnancy

Treatment

Treatment options include the use of NSAIDs and hormone suppression in order to bring symptomatic relief. Of course, hysterectomy permanently correct the problem by eliminating infiltrating the endometrium. Those who believe that the cause of the disorder is an excess of estrogen or at least exacerbating symptoms, recommend avoiding products that contain xenoestrogens or recominendan use natural progesterone supplements.

Prognosis

None reported an increased risk of cancer associated with adenomyosis. Because the disorder is dependent on estrogen, menopause is a natural healing process. Patients with adenomyosis often also have a lehiomioma or endometriosis.


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