View source for Adenomyosis

==Background==
[[File:Adenomyosis.jpg|thumb|Adenomyosis uteri seen during laparoscopy: soft and enlarged uterus; the blue spots represent subserous endometriosis.]]
*Uterine disorder characterized by endometrial glands and stroma being present within the myometrium resulting in hypertrophy of the surrounding myometrium 
*Two histopathological forms:
**Diffuse – results in the uterus being uniformly enlarged and boggy
**Focal (also known as an adenomyoma) – can appear similar to a fibroid but does not have a pseudocapsule
*Pathogenesis is not well understood

==Clinical Features==
*Heavy [[vaginal bleeding]] 
*Dysmenorrhea
*Chronic [[pelvic pain]]

==Differential Diagnosis==
{{VB DDX nonpregnant}}

==Evaluation==
[[File:Adenomyosis MRI.jpg|thumb|Sagittal MRI showing uterus with adenomyosis in the posterior wall: gross enlargement with many foci of hyperintensity.]]
*Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus
*Transvaginal [[pelvic ultrasound|US]] 
*MRI usually reserved in cases when providers are seeking to distinguish between adenomysosis and leiomyomas <ref> Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19 Spec No:S161-S170. doi:10.1148/radiographics.19.suppl_1.g99oc03s161 </ref>
*Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy

==Management==
*Hysterectomy is the definitive treatment 
*Alternative options include 
**Hormonal therapy such as with a levonorgestrel IUD <ref> Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999;60(3):173-175. doi:10.1016/s0010-7824(99)00075-x </ref> <ref> Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68(3):426-429. doi:10.1016/s0015-0282(97)00245-8 </ref> <ref> Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009;79(3):189-193. doi:10.1016/j.contraception.2008.11.004 </ref> 
*Uterine artery embolization
*Uterus sparing resection

==Disposition==
*Final disposition should be made based on hemodynamic stability of the patient
*If hemodynamically stable without clinically significant bleeding, patient can be discharged with gynecology referral

==See Also==
*[[Vaginal Bleeding (Non-Pregnant)]]

==External Links==

==References==
<references/>
[[Category:OBGYN]]