AKT · Obstetrics & gynaecology/Menstrual & benign gynaelow yield

Adenomyosis

Endometrial tissue within the myometrium

Overview

Presence of endometrial tissue within the uterine muscle (myometrium), causing heavy painful periods and a diffusely enlarged tender "boggy" uterus — classically in older, multiparous women near the end of their reproductive years. The key fibroids/endometriosis mimic.

Recognise

Heavy menstrual bleeding (menorrhagia) AND painful periods (dysmenorrhoea) together
Diffusely enlarged, globular, TENDER "boggy" uterus
Often older parous women; symptoms ease after menopause

Red flags

Severe anaemia from heavy bleeding

Differentials & how to tell them apart

Fibroidsenlarged but FIRM and non-tender with discrete masses; adenomyosis is diffusely boggy and TENDER

Endometriosistissue OUTSIDE the uterus; pelvic pain/subfertility, normal-sized uterus

Endometrial cancerpostmenopausal bleeding, biopsy

Investigations

Transvaginal USS may suggest it; MRI is the most accurate non-invasive test. Definitive diagnosis is histological (after hysterectomy).

Management

Levonorgestrel IUS (or tranexamic acid/NSAID) for symptoms

1Symptom control as for heavy menstrual bleeding: levonorgestrel IUS first-line; tranexamic acid/NSAID; COCP or progestogen.
2Definitive treatment is hysterectomy if symptoms are severe and the family is complete.

Levonorgestrel IUS / tranexamic acid / NSAID — symptom control (as for heavy menstrual bleeding)

COCP or progestogen — hormonal suppression

Hysterectomy — definitive if family complete

Key points

The discriminator from fibroids is the texture: adenomyosis = diffusely enlarged, TENDER, boggy uterus; fibroids = firm, non-tender, discrete masses. Adenomyosis classically affects older multiparous women.

Monitor & prognosis

Symptoms, anaemia.

Resolves after menopause; hysterectomy is curative.

Source: NICE CKS; QuackQuackMed cross-check