Adenomüoos

Adenomüoos, known in English as adenomyosis, is a gynecological condition in which endometrial tissue—the lining of the uterus—becomes embedded within the muscular wall of the uterus (the myometrium). This invasion can cause the uterus to enlarge and may disrupt uterine contractions.

Symptoms commonly include heavy or prolonged menstrual bleeding, severe menstrual cramps, chronic pelvic pain, and sometimes pain during intercourse. The condition can be associated with infertility or reduced fertility, though many people have no fertility issues. Symptoms often worsen with age and may vary in severity.

The exact cause of adenomüoos is not fully understood. Theories include invasion of endometrial tissue into the myometrium after uterine injury or surgery, abnormal remodeling of the myometrium, or metaplastic transformation of Müllerian tissue. Estrogen appears to promote disease activity, and symptoms may lessen after menopause or with hormonal suppression.

Diagnosis relies on clinical evaluation and imaging. Magnetic resonance imaging (MRI) provides the most accurate assessment, while transvaginal ultrasound can reveal a thickened or heterogeneous myometrium and other indicative features. Definitive histology is typically obtained after hysterectomy, but is not routinely required for management.

Treatment depends on age, symptoms, and fertility desires. Medical options include nonsteroidal anti-inflammatory drugs for pain, hormonal therapies such as combined oral contraceptives, progestins, the levonorgestrel-releasing intrauterine system, and gonadotropin-releasing hormone agonists. For those who wish to preserve fertility, conservative surgical approaches to remove adenomyotic tissue may be pursued. Hysterectomy remains the definitive treatment for those who have completed childbearing or when other treatments fail.