Adenomyoosi

Adenomyoosi, also known as adenomyosis, is a gynecologic condition in which endometrial glands and stroma reside within the myometrium, the muscular wall of the uterus. It may be focal or diffuse and often results in uterine enlargement.

Most commonly diagnosed in women aged 40 to 50 and who have had pregnancies, but it can occur in younger women. The symptoms include dysmenorrhea (painful periods), heavy or prolonged menstrual bleeding (menorrhagia), chronic pelvic pain, and dyspareunia. Some individuals are asymptomatic or have milder symptoms.

Diagnosis relies on imaging, primarily transvaginal ultrasound and MRI. MRI is more accurate in detecting adenomyosis and distinguishing it from fibroids. Histologic confirmation is typically obtained after hysterectomy.

Treatment is individualized based on age, symptom severity, and fertility goals. Medical options include NSAIDs for pain, hormonal therapies such as combined estrogen-progestin contraceptives, progestins, and the levonorgestrel-releasing intrauterine system. Gonadotropin-releasing hormone (GnRH) agonists may provide temporary relief but are not suitable for long-term use.

For women who do not wish to preserve fertility, hysterectomy is considered a definitive treatment. Uterine-sparing approaches include adenomyomectomy, uterine artery embolization, high-intensity focused ultrasound (HIFU), and MR-guided focused ultrasound, with varying evidence on symptom relief and fertility outcomes.

Prognosis is variable; symptoms may persist for years and may improve after menopause. The condition can impact quality of life and may be associated with infertility, depending on the extent of disease and coexisting conditions.