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Adenomyosis

Adenomyosis is a medical condition characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). more...

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The condition is typically found in women in the ages between 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 Cesarean sections, 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 (MR). 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 uterine fibroids.

MR 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 uterine fibroids the uterus will have a thickened junctional zone with diminished signal on both T1 and T2 weighted sequences due to succeptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the junctional zone greater than 10 or 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, to endometrial ablation or hysterectomy for a more or less permanent cure.

Those that believe an excess of estrogen is the cause or adenomyosis, or that it aggravates the symptoms, recommend avoiding products with xenoestrogens and/or recommend taking natural progesterone supplements.

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Interstitial cystitis often seen with adenomyosis.(Women's Health) : An article from: Family Practice News $5.95 Adenomyosis frequently missed on ultrasound. (Fibroids Falsely Found).(endometriosis) : An article from: Family Practice News $5.95
Adenomyosis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References $39.36

UAE effective in small study of women with adenomyosis
NICE, FRANCE -- Uterine artery embolization should not be withheld from women with adenomyosis, according to investigators who conducted a prospective, ...
Interstitial cystitis and adenomyosis frequently coexist in chronic pelvic pain syndrome
NEW YORK -- Interstitial cystitis often coexists with adenomyosis, just as it does with endometriosis, Stephen A. Grochmal, M.D., said at an international ...
MRI adds value after transvaginal ultrasound diagnosis of adenomyosis: suspicious screen - Gynecology
CHICAGO -- Magnetic resonance imaging offers valuable information following transvaginal ultrasound diagnosis of adenomyosis, Dr. Thomas Zacharia reported ...
Adenomyosis often mistaken for fibroids on US - Underdiagnosed Cause of Pelvic Pain
NEW YORK--Too many sonographers see fibrodis where they should be seeing adenomyosis, Dr. Edward A. Lyons said at the 12th World Congress on Ultrasound ...
Hysteroscopic findings clue adenomyosis diagnosis - Can Individualize Menorrhagia Therapy
BALTIMORE--A cratered appearance of the endometrial cavity on hysteroscopy can be used to diagnose adenomyosis preoperatively and may be used to individualize ...
Comorbid Adenomyosis Not an Issue
DENVER -- The presence of comorbid adenomyosis is no obstacle to successful uterine artery embolization for uterine fibroids, Dr. Reena C. Jha reported ...
New rules apply after NovaSure
CHICAGO -- The exact state of the uterus 1 year after global endometrial ablation with Nova-Sure is largely unknown, but certain characteristics are ...
IS THE NOVASURE SYSTEM ETHICAL?
Some Have Questioned the Treatment's Use in Catholic Facilities Mercy Health System, Conshohocken, PA, has had inquiries concerning whether a new procedure, ...

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