Adenomyosis
Adenomyosis is a benign condition characterized by the presence of endometrial glands and stroma within the myometrium. This results in reactive hypertrophy and hyperplasia of the surrounding smooth muscle, leading to a diffusely enlarged (“globular”) uterus.
Clinical Triad
- Menorrhagia: Heavy menstrual bleeding (common).
- Dysmenorrhea: Often severe and progressive.
- Enlarged, Tender Uterus: Typically symmetrically enlarged on bimanual examination.
Diagnostic Modalities
| Method | Key Findings |
|---|---|
| Transvaginal US | Myometrial cysts, asymmetric wall thickening, heterogeneous echotexture. |
| MRI | Gold standard imaging: Thickening of the junctional zone (> 12 mm). |
High-Yield Exam Pearl:
- Differential: Adenomyosis is often confused with fibroids (leiomyomas). Key difference: Fibroids are well-circumscribed, discrete masses, while adenomyosis causes a diffuse, globular enlargement.
- Treatment: Primarily symptomatic (NSAIDs, hormonal contraception, or LNG-IUD). Definitive treatment is a hysterectomy if fertility is not desired and symptoms are debilitating.