Adenomyosis is a benign condition where endometrial tissue grows into the myometrium. It causes the uterus to enlarge asymmetrically, especially on the posterior wall. Women with adenomyosis typically experience heavy menstrual bleeding and painful periods that can occur throughout the month. Ultrasound and MRI can detect adenomyosis by showing cysts in the thickened myometrium and an indistinct endomyometrial junction. Treatment depends on a woman's age and fertility desires, ranging from medication like NSAIDs and oral contraceptives to hysterectomy for older, parous women.

1. ADENOMYOSIS

2. DEFENITION
• Benign ingrowing of endometrium into the
myometrium
• Both glandular and stromal components of
endometrium are involved
• Etiology unknown

4. PATHOLOGY
• Uterus enlarged(myometrial hyperplasia)
• Asymmetrical enlargement, more on
posterior wall
• Size not more than 12-14 weeks of a gravid
uterus
• Cut section: thickening of uterine wall-
characteristic trabeculated appearance
• No capsule

5. Gross photograph of uterus showing thickened
endometrium (hyperplasia) with trabeculated
appearance of myometrium (adenomyosis)

6. • Microscopy-glandular tissue surrounded
by stromal cells in the myometrium
• Ectopic endometrium -separate from the
underlying basal endometrium, located
deeper than the endomyometrial junction
by more than one HPF
• Response to steroids minimal- invasion
mainly in the basal layer

9. CLINICAL FEATURES
• Usually asymptomatic, detected on routine
examination
• Usually parous , in their forties
• Can coexist with endometriosis and fibroids

10. SYMPTOMS
• Menorrhagia(increased surface area &
endometrial hyperplasia) or
menometrorrhagia
• Congestive dysmenorrhea( cramping starts
with the menstrual flow or days earlier)
• Some can have cramps throughout the month
aggravating during the periods
• Deep dyspareunia premenstrually

11. SIGNS
• Abdominal examination- uterus enlarged(
not more than 14 weeks)
• Pelvic examination- uniform uterine
enlargement with no restriction of mobility
• Uterus may be softer than normal
• Findings altered if there is associated
endometriosis

12. ULTRASOUND
• Enlarged uterus –asymmetrical enlargement
of usually the posterior wall
• Myometrium – multiple small cysts,
increased vascularity, heterogeneous
texture
• Endomyometrial junction indistinct
• If localised, misdiagnosed for fibroids

14. MRI
• Widening of junctional zone- thickness
12mm or more
• Differentiate localised adenomyoma and
fibroid- lack distinct borders and usually
posterior

16. MANAGEMENT
• Depends on age and desire for future fertility
• Secondary dysmenorrhea- NSAIDS & OCPs
• GnRH agonists, LNG-IUS
• Medical management- not very effective
• Total hysterectomy (parous women >40)
• Resection (younger women, localised
adenomyosis)

17. THANK YOU