bubble_chart Overview

Adenomyosis, also known as intrinsic endometriosis, is a condition where the endometrium invades the myometrium, representing a special type of endometriosis. It can coexist with "external" or primarily pelvic endometriosis. The endometrium can invade the myometrium in two forms: diffuse and focal. The former involves the ectopic endometrium invading the entire myometrium, with varying extents and depths in different areas. The latter occurs when the ectopic endometrium only affects a specific portion of the myometrium, resembling a uterine fibroid, but without a clear boundary (pseudocapsule) from the surrounding normal tissue.

bubble_chart Pathological Changes

The lesion exhibits alternating thick bands of muscle fibers and fibrous bands, with dark red hemorrhagic spots or small areas present within, rarely polypoid endometrial tissue protruding toward the serosal layer. Histological sections reveal endometrial glands and stroma.

bubble_chart Clinical Manifestations

Secondary dysmenorrheal occurs in older women, typically around the age of 40, where dysmenorrheal gradually worsens, often becoming spasmodic to the point of being unable to maintain daily work. Dysmenorrheal is caused by ectopic membrane edema, bleeding, and stimulation of the muscular wall leading to spasmodic contractions during menstruation.

The amount of menstruation increases, with prolonged menstruation, and a few may experience spotting before or after menstruation. This is due to the enlargement of the uterus, increased membrane area within the uterine cavity, and the impact of ectopic uterine membrane between the uterine muscle walls on uterine muscle fiber contractions.

Bimanual examination often reveals a uniformly enlarged uterus with tenderness, but adenomyosis can also be present in uteri of normal size or even smaller than normal.

bubble_chart Diagnosis

Secondary progressive dysmenorrhea occurring in middle-aged women of childbearing age should raise suspicion of uterine adenomyosis. If accompanied by hypermenorrhea, prolonged menstrual periods, and uterine enlargement, the likelihood of uterine adenomyosis is even higher. Uterine hysterosalpingography may reveal contrast medium entering the myometrium at one or several locations, forming diverticulum-like shadows, but the positive rate is only about 20%. The definitive diagnosis still relies on gross uterine examination and histopathological evaluation.

bubble_chart Treatment Measures

For patients with adenomyosis who no longer have fertility requirements, a total hysterectomy is preferable, with efforts made to preserve the ovaries. If combined with pelvic endometriosis, the lesions should be removed as much as possible while preserving ovarian function, allowing the patient to reach natural menopause. For those who wish to conceive, hormone therapy can be administered for 6 to 12 months, with the hope of achieving pregnancy shortly after discontinuation. If discovered during surgical exploration, consideration should be given to excising the adenomyoma while preserving the uterus.

bubble_chart Prognosis

The growth of ectopic lesions in the uterine membrane is slow, often regressing during pregnancy and ceasing to develop after menopause, so the prognosis is generally favorable. However, if the lesions are too extensive or involve the intestines, severe complications such as intestinal obstruction may occur.

Uterine membrane ectopic disease rarely complicates pregnancy, and even after pregnancy, it is prone to late abortion, premature labor, or tubal pregnancy.

The surgical treatment for uterine membrane ectopic disease is highly effective. Young patients can even regain fertility. The likelihood of uterine membrane ectopic disease becoming malignant is very small.