Diferencia entre revisiones de «Adenomyosis»
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==Background== | ==Background== | ||
[[File:Adenomyosis.jpg|thumb|Adenomyosis uteri seen during laparoscopy: soft and enlarged uterus; the blue spots represent subserous endometriosis.]] | |||
*Uterine disorder characterized by endometrial glands and stroma being present within the myometrium resulting in hypertrophy of the surrounding myometrium | *Uterine disorder characterized by endometrial glands and stroma being present within the myometrium resulting in hypertrophy of the surrounding myometrium | ||
*Two histopathological forms: | *Two histopathological forms: | ||
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==Clinical Features== | ==Clinical Features== | ||
*Heavy | *Heavy [[vaginal bleeding]] | ||
*Dysmenorrhea | *Dysmenorrhea | ||
*Chronic pelvic pain | *Chronic [[pelvic pain]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{VB DDX nonpregnant}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:Adenomyosis MRI.jpg|thumb|Sagittal MRI showing uterus with adenomyosis in the posterior wall: gross enlargement with many foci of hyperintensity.]] | |||
*Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus | *Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus | ||
*Transvaginal US | *Transvaginal [[pelvic ultrasound|US]] | ||
*MRI usually reserved in cases when providers are seeking to distinguish between adenomysosis and leiomyomas <ref> Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19 Spec No:S161-S170. doi:10.1148/radiographics.19.suppl_1.g99oc03s161 </ref> | *MRI usually reserved in cases when providers are seeking to distinguish between adenomysosis and leiomyomas <ref> Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19 Spec No:S161-S170. doi:10.1148/radiographics.19.suppl_1.g99oc03s161 </ref> | ||
*Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy | *Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy | ||
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*If hemodynamically stable without clinically significant bleeding, patient can be discharged with gynecology referral | *If hemodynamically stable without clinically significant bleeding, patient can be discharged with gynecology referral | ||
==See Also== | |||
*[[Vaginal Bleeding (Non-Pregnant)]] | |||
==External Links== | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:OBGYN]] | |||
Revisión actual - 17:27 12 ene 2021
Background
- Uterine disorder characterized by endometrial glands and stroma being present within the myometrium resulting in hypertrophy of the surrounding myometrium
- Two histopathological forms:
- Diffuse – results in the uterus being uniformly enlarged and boggy
- Focal (also known as an adenomyoma) – can appear similar to a fibroid but does not have a pseudocapsule
- Pathogenesis is not well understood
Clinical Features
- Heavy vaginal bleeding
- Dysmenorrhea
- Chronic pelvic pain
Differential Diagnosis
Nonpregnant Vaginal Bleeding
Systemic Causes
- Cirrhosis
- Coagulopathy (Von Willebrand disease, ITP)
- Group A strep vaginitis (prepubertal girls)
- Hormone replacement therapy
- Anticoagulants
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Hypothyroidism
- Polycystic Ovary Syndrome
- Secondary anovulation
Reproductive Tract Causes
- Adenomyosis
- Atrophic endometrium
- Dysfunctional uterine bleeding
- Endometriosis
- Leiomyoma (Fibroid)
- Foreign Body
- Infection (vaginitis, PID)
- IUD
- Neoplasia (especially in women >45 years old or in younger women with other risk factors)
- Vaginal Trauma
Evaluation
- Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus
- Transvaginal US
- MRI usually reserved in cases when providers are seeking to distinguish between adenomysosis and leiomyomas [1]
- Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy
Management
- Hysterectomy is the definitive treatment
- Alternative options include
- Uterine artery embolization
- Uterus sparing resection
Disposition
- Final disposition should be made based on hemodynamic stability of the patient
- If hemodynamically stable without clinically significant bleeding, patient can be discharged with gynecology referral
See Also
External Links
References
- ↑ Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19 Spec No:S161-S170. doi:10.1148/radiographics.19.suppl_1.g99oc03s161
- ↑ Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999;60(3):173-175. doi:10.1016/s0010-7824(99)00075-x
- ↑ Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68(3):426-429. doi:10.1016/s0015-0282(97)00245-8
- ↑ Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009;79(3):189-193. doi:10.1016/j.contraception.2008.11.004