Adenomyotic

Adenomyotic is an adjective referring to tissue, lesions, or findings associated with adenomyosis, a gynecologic condition in which endometrial glands and stroma are located within the myometrium.

Most often, adenomyosis affects women of reproductive age and can be diffuse or focal. The exact cause is unknown; theories include invasion of endometrium into the myometrium after childbirth, metaplasia of myometrial cells, or stem cell–mediated processes. Risk factors include high parity and advanced age within the reproductive years, but the condition can occur in younger women as well. Adenomyotic changes may coexist with endometriosis or fibroids.

Symptoms commonly include dysmenorrhea (painful periods), menorrhagia (heavy bleeding), chronic pelvic pain, and an enlarged, tender uterus on examination. Some individuals have infertility or adverse pregnancy outcomes.

Diagnosis is primarily by imaging; transvaginal ultrasound and MRI can show a thickened junctional zone, myometrial heterogeneity, or focal adenomyotic nodules. Histology confirms when tissue is examined after surgery.

Management depends on symptoms and fertility plans. Medical therapy includes NSAIDs and hormonal regimens (combined oral contraceptives, progestins, levonorgestrel-releasing IUD, or GnRH agonists) to reduce bleeding and pain. For women who wish to preserve fertility or have refractory symptoms, conservative surgical options to remove adenomyotic tissue or reduce uterus size may be offered, though complete excision is challenging. In cases not desiring continued fertility, hysterectomy provides definitive relief. Alternative therapies such as uterine artery embolization or MR-guided focused ultrasound have been explored, with variable results.

Etymology: derived from Greek adenos (gland) and mys (muscle) with -osis.