Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Endometriosis is the presence of endometrial glandular tissue outside of the uterine cavity. Common sites are ovary, rectovesical pouch, uterosacral ligaments and pelvic peritoneum. If the tissue is found in the uterine smooth muscle, it is termed adenomyosis. Pathological features arise as the deposits are under hormonal control, so they bleed during menstruation. Bleeding provokes inflammation, which leads to adhesions and chronic pain. Symptoms include dysmenorrhoea, chronic pelvic pain, subfertility and dyspareunia. Bowel and bladder symptoms may also be present. Examination findings include fixed tender retroverted uterus with uterosacral ligament nodules. Non-steroidal analgesia can help the pain, but persistent pain may benefit from ovulation suppression using combined pill, hormone-releasing IUCDs, or GnRH agonists. Surgical treatment includes laparoscopy and excision or ablation of deposits or, if no wishes for fertility, a hysterectomy and bilateral salpingo-oophorectomy.
Acquired uterine conditions, reproductive surgery, and recurrent implantation failure
Efstratios M. Kolibianakis, Christos A. Venetis in Recurrent Implantation Failure, 2019
The recognized clinical manifestations of adenomyosis include abnormal uterine bleeding and pelvic pain (dysmenorrhea and/or chronic pelvic pain). The presence of adenomyosis is found to be associated with infertility and impaired implantation. By considering the pregnancy rate as a means to evaluate implantation, Vercellini et al.,26 in a systematic review, examined the impact of adenomyosis on IVF results. Either ultrasound or MRI was used to diagnose adenomyosis. They found that patients with adenomyosis had significantly lower clinical pregnancy rates (RR 0.72, 95% CI 0.55–0.95), although the study was unable to detect a difference in implantation rates. Furthermore, a limitation of the results reported was the significant heterogeneity among the studies.
Ultrasound assessment of endometriosis
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh in An Atlas of ENDOMETRIOSIS, 2020
The diagnosis of adenomyosis remains a particular issue from a medical imaging point of view. It is reasonable to say that, to date, magnetic resonance imaging (MRI) is regarded as perhaps the most effective modality in this respect, but presents obvious problems with regard to practical aspects and cost in particular. The availability of high-definition G-S imaging, as well as considerable advances in CDI techniques, has nevertheless had considerable impact in this respect. Diffuse myometrial thickening with irregular textural changes, enlargement of myometrial glands, poor differentiation of the myometrial-endometrial interface and, in particular, increased myometrial vascularity are all ultrasound features often found in cases of known endometriosis and/or confirmed adenomyosis.
Comparison of high-intensity focused ultrasound for the treatment of internal and external adenomyosis based on magnetic resonance imaging classification
Published in International Journal of Hyperthermia, 2023
Feng Xu, Zhenjiang Lin, Yangyang Wang, Chunmei Gong, Min He, Qing Guo, Zhibiao Wang, Zhang Lian
Clinically, around two-thirds of patients with adenomyosis are symptomatic and thus need to be treated [4]. The main symptoms of adenomyosis are dysmenorrhea and menorrhagia. This disease also has a great impact on the fertility of childbearing age women [5–7]. The diagnosis of adenomyosis is suspected by clinical evaluation and confirmed with ultrasound and magnetic resonance imaging (MRI). MRI offers the best soft tissue resolution and can clearly show the appearance of adenomyotic lesions in internal or external layers of the myometrium. The typical MRI features of adenomyotic lesions include ill-defined low signal intensity areas with hyperintensity foci in the lesions on T2-weighted images (T2WI) [8–9]. Kishi et al. classified adenomyosis as four types based on the location of adenomyotic lesion and the relationship between the lesion and the endometrium, junction zone, myometrium, and the serosa of the uterus revealed by MRI: type I (intrinsic), type II (extrinsicl), type III (intramural) and type IV (indeterminate) [10].
Evaluation of high intensity focused ultrasound treatment for different types of adenomyosis based on magnetic resonance imaging classification
Published in International Journal of Hyperthermia, 2022
Chunmei Gong, Yangyang Wang, Fajin Lv, Lian Zhang, Zhibiao Wang
The common symptoms of adenomyosis include menstrual pain, heavy menstrual blood volume, and a tender, enlarged, and boggy uterus [5–9]. Transvaginal ultrasound (TVUS) is used in the diagnosis of adenomyosis and has a relatively high sensitivity. However, sonographic accuracy appears to be more operators dependent [10–12]. Magnetic resonance imaging (MRI) can clearly show the appearance of adenomyosis with symmetric or asymmetric lesions of internal or external layers of the myometrium. The typical MRI features of adenomyotic lesions are ill-defined low signal intensity areas with hyperintensity foci in the lesions on T2-weighted images [13]. In 2012, Kishi et al. classified adenomyosis as four subtypes based on the relationship between the lesion and the uterine structural components (the endometrium, the junctional zone, the myometrium, and the serosa) revealed by MRI: type I (intrinsic), type II(extrinsicl), type III (intramural) and type IV(indeterminate) [14]. Recently, several other classifications have been proposed, but there remains no consensus classification [10,15].
A cohort study of the efficacy of the dienogest and the gonadotropin-releasing hormone agonist in women with adenomyosis and dysmenorrhea
Published in Gynecological Endocrinology, 2022
Miaomiao Ji, Ming Yuan, Xue Jiao, Qiuju Li, Yufei Huang, Jing Li, Guoyun Wang
Adenomyosis, which is a common benign gynecological disease, is distinguished by the presence of heterotopic endometrial glands and stroma with invasion of the myometrium and diffuse growth or localized hyperplasia in the myometrium. The main manifestations of adenomyosis are dysmenorrhea, menorrhagia, and infertility, which seriously affect the physical and mental health of females. The management of adenomyosis remains controversial in which the current treatment mainly includes drugs, surgery, or a combination of the two. The exhaustive treatment for adenomyosis is hysterectomy [1], but this is not feasible for patients who have fertility requirements and prefer to preserve their uterus. Several hormonal treatments, i.e. oral contraceptive pills (OCs), progestin, gonadotropin-releasing hormone agonist (GnRH-a), levonorgestrel-releasing intrauterine device (LNG-IUD), and nonhormonal drugs, e.g. nonsteroidal anti-inflammatory drugs, are currently used to control abnormal uterine bleeding and pain in adenomyosis [2]. GnRH-a has previously been demonstrated to produce a constant hypoestrogenic state in patients with adenomyosis [3] resulting in perimenopausal symptoms, such as hot flashes, osteoporosis, and vaginal dryness, causing difficulties with prolonged use. Hence, a well-tolerated and effective drug for long-term treatment of adenomyosis is highly needed.
Related Knowledge Centers
- Adenomyoma
- Anemia
- Dysmenorrhea
- Menstrual Cycle
- Menstruation
- Myometrium
- Endometrium
- Endometriosis
- Heavy Menstrual Bleeding
- Dyspareunia