adenomioz

Adenomioz, also known as adenomyosis, is a gynecological condition in which endometrial tissue—the lining of the uterus—extends into the muscular wall of the uterus (the myometrium). This intrusion can cause uterine enlargement and changes in uterine contractility, leading to a variety of symptoms.

Common symptoms include heavy and prolonged menstrual bleeding, painful periods (dysmenorrhea), chronic pelvic or lower abdominal pain, and sometimes pain during sexual intercourse. Some individuals may also experience anemia from blood loss. The severity of symptoms does not always correlate with the extent of tissue invasion.

The exact cause of adenomyosis is not fully understood. Theories include invasion of endometrial tissue into the myometrium, tissue remodeling after childbirth, or abnormalities at the junction between endometrium and myometrium. Risk factors include prior pregnancies and extended estrogen exposure, though the condition can occur in various ages within the reproductive years.

Diagnosis is typically based on imaging. Transvaginal ultrasound and magnetic resonance imaging (MRI) are the primary noninvasive tools used to support a diagnosis and to distinguish adenomyosis from other conditions such as fibroids. A definitive histopathologic diagnosis is possible only after hysterectomy, so imaging findings and clinical features guide management in most cases.

Adenomyosis can be diffuse, affecting the whole uterus, or focal, forming an adenomyoma. It is sometimes categorized as intrinsic or extrinsic based on tissue location relative to the junctional zone.

Treatment is individualized and depends on symptoms and fertility desires. Medical options include nonsteroidal anti-inflammatory drugs, tranexamic acid, and hormonal therapies such as combined oral contraceptives, progestins, or a levonorgestrel-releasing intrauterine system. GnRH agonists can reduce symptoms but are generally used short term. For those seeking uterus-sparing approaches, surgical options such as adenomyomectomy exist, while uterine artery embolization and MR-guided focused ultrasound are used in select centers. Hysterectomy remains a definitive option for those who have completed childbearing or with severe disease. Adenomyosis can impact fertility and pregnancy outcomes, but pregnancies are possible after treatment in some cases.