Endometriosis interna

Alternative names 
Adenomyosis; Adenomyoma

Definition
Adenomyosis is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, extends into the fibrous and muscular tissue of the uterus.

Causes, incidence, and risk factors

The diagnosis of adenomyosis can only be made after a pathologist examines uterine wall samples.

The cause is unknown. Sometimes a focal area of adenomyosis appears to cause a mass or growth within the uterus, which is called an adenomyoma. The disease usually occurs in women older than 30 who have borne children and rarely occurs in women who have not carried a pregnancy to term.

Some degree of adenomyosis affects 60% of women, but in most cases is not symptomatic.

Symptoms

     
  • The uterus is often 2-3 times the normal size  
  • Prolonged or heavy menstrual bleeding  
  • Painful menstruation       o New onset of menstrual cramping       o Becomes increasingly worse

Note: In many cases, the woman may not have any symptoms.

Signs and tests

Pelvic examination may reveal an enlarged, slightly softened uterus, a uterine mass, or uterine tenderness. Additionally, an ultrasound examination of the uterus may be helpful in differentiating between adenomyosis and other uterine tumors.

Treatment

Usually the only treatment is pain medication (analgesics). A hysterectomy may be necessary in women with severe symptoms who are not approaching menopause.

Most treatment attempts with hormones have been unsuccessful.

Expectations (prognosis)

Symptoms usually resolve after menstruation ceases (menopause). A hysterectomy completely resolves symptoms.

Complications

Oral contraceptives may aggravate symptoms of heavy bleeding or pain.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of adenomyosis.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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