Download PDF
Semin Reprod Med 2020; 38(02/03): 144-150
DOI: 10.1055/s-0040-1721795
Review Article

Symptoms of Adenomyosis and Overlapping Diseases

Keith Isaacson
1   Department of OB/GYN Harvard Medical School, Department of MIGS and Infertility, Newton, Massachusetts
,
Megan Loring
2   Department of MIGS and Infertility, Newton Wellesley Hospital, Department of MIGS and Infertility, Newton, Massachusetts
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms. Systematic review of PubMed between January 1972 and April 2020. Search strategy included: “adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[Text Word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word]. Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. Included articles described: pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis. Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. Prevalence estimates range from 20% to 88.8% in symptomatic women (average 30–35%) with most diagnosed between 32–38 years old. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report younger symptomatic women are being diagnosed with adenomyosis based on both magnetic resonance imaging (MRI) and/or transvaginal ultrasound (TVUS). High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis. Adenomyosis remains a challenge to identify, assess and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathological and imaging diagnoses to gain deeper understandings of adenomyosis.

Keywords

adenomyosis - endometriosis - dysmenorrhea - dyspareunia - heavy menstrual bleeding - infertility


Publication History

Article published online:
22 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Vercellini P, Vigano P, Somigliana E, Daguati R, Abbiati A, Fedele L. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 2006; 20 (04) 465-477
    CrossrefPubMedGoogle Scholar
  • 2 Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand 2017; 96 (06) 715-726
    CrossrefPubMedGoogle Scholar
  • 3 Garcia L, Isaacson K. Adenomyosis: Review of the Literature. J Minim Invasive Gynecol 2011; 18 (04) 428-437
    CrossrefPubMedGoogle Scholar
  • 4 Vannuccini S, Tosti C, Carmona F. et al. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online 2017; 35 (05) 592-601
    CrossrefPubMedGoogle Scholar
  • 5 Templeman C. Adolescent endometriosis. Obstet Gynecol Clin North Am 2009; 36 (01) 177-185
    CrossrefPubMedGoogle Scholar
  • 6 Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update 1998; 4: 312-322
    CrossrefPubMedGoogle Scholar
  • 7 Ballweg ML. Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol 2004; 18 (02) 201-218
    CrossrefPubMedGoogle Scholar
  • 8 Togashi K, Nishimura K, Itoh K. et al. Adenomyosis: diagnosis with MR imaging. Radiology 1988; 166 (1 Pt 1): 111-114
    CrossrefPubMedGoogle Scholar
  • 9 Leyendecker G, Bilgicyildirim A, Inacker M. et al. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol Obstet 2015; 291: 917-932
    CrossrefPubMedGoogle Scholar
  • 10 Tellum T, Matic GV, Dormagen JB. et al. Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker. Eur Radiol 2019; 29: 6971-6981
    CrossrefPubMedGoogle Scholar
  • 11 Chapron C, Tosti C, Marcellin L. et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod 2017; 32: 1393-1401
    CrossrefPubMedGoogle Scholar
  • 12 Marcellin L, Santulli P, Bortolato S. et al. Anterior Focal Adenomyosis and Bladder Deep Infiltrating Endometriosis: Is There a Link?. J Minim Invasive Gynecol 2018; 25: 896-901
    CrossrefPubMedGoogle Scholar
  • 13 Benagiano G, Brosens I, Habiba M. Structural and molecular features of the endomyometrium in endometriosis and adenomyosis. Hum Reprod Update 2014; 20 (03) 386-402
    CrossrefPubMedGoogle Scholar
  • 14 Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril 2018; 109 (03) 380-388
    CrossrefPubMedGoogle Scholar
  • 15 Dakhly DM, Abdel Moety GA, Saber W, Gad Allah SH, Hashem AT, Abdel Salam LO. Accuracy of hysteroscopic endomyometrial biopsy in diagnosis of adenomyosis. J Minim Invasive Gynecol 2016; 23 (03) 364-371
    CrossrefPubMedGoogle Scholar
  • 16 Stamatopoulos CP, Mikos T, Grimbizis GF. et al. Value of Magnetic Resonance Imaging in Diagnosis of Adenomyosis and Myomas of the Uterus. J Minim Invasive Gynecol 2012; 19: 620-626
    CrossrefPubMedGoogle Scholar
  • 17 Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod 2012; 27: 3432-3439
    CrossrefPubMedGoogle Scholar
  • 18 Struble J, Reid S, Bedaiwy MA. Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. J Minim Invasive Gynecol 2016; 23 (02) 164-185
    CrossrefPubMedGoogle Scholar
  • 19 Naftalin J, Hoo W, Nunes N, Holland T, Mavrelos D, Jurkovic D. Association between ultrasound features of adenomyosis and severity of menstrual pain. Ultrasound Obstet Gynecol 2016; 47: 779-783
    CrossrefPubMedGoogle Scholar
  • 20 Naftalin J, Hoo W, Pateman K, Mavrelos D, Foo X, Jurkovic D. Is adenomyosis associated with menorrhagia?. Hum Reprod 2014; 29: 473-479
    CrossrefPubMedGoogle Scholar
  • 21 Pinzauti S, Lazzeri L, Tosti C. et al. Transvaginal sonographic features of diffuse adenomyosis in 18–30-year-old nulligravid women without endometriosis: Association with symptoms. Ultrasound Obstet Gynecol 2015; 46: 730-736
    CrossrefPubMedGoogle Scholar
  • 22 Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol 2018; 51: 16-24
    CrossrefPubMedGoogle Scholar
  • 23 Dietrich JE. An update on adenomyosis in the adolescent. Curr Opin Obstet Gynecol 2010; 22 (05) 388-392
    CrossrefPubMedGoogle Scholar
  • 24 Takeuchi H, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Jinushi M. Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases. Fertil Steril 2010; 94 (03) 862-868
    CrossrefPubMedGoogle Scholar
  • 25 Bulun SE. Endometriosis. N Engl J Med 2009; 360 (03) 268-279
    CrossrefPubMedGoogle Scholar
  • 26 Dunselman GAJ, Vermeulen N, Becker C. et al. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (03) 400-412
    CrossrefPubMedGoogle Scholar
  • 27 Luciano DE, Exacoustos C, Albrecht L. et al. Three-dimensional ultrasound in diagnosis of adenomyosis: histologic correlation with ultrasound targeted biopsies of the uterus. J Minim Invasive Gynecol 2013; 20: 803-810
    CrossrefPubMedGoogle Scholar
  • 28 Tellum T, Qvigstad E, Skovholt EK, Lieng M. In Vivo Adenomyosis Tissue Sampling Using a Transvaginal Ultrasound–guided Core Biopsy Technique for Research Purposes: Safety, Feasibility, and Effectiveness. J Minim Invasive Gynecol 2019; 26: 1357-1362
    CrossrefPubMedGoogle Scholar
  • 29 Kissler S, Zangos S, Kohl J. et al. Duration of dysmenorrhoea and extent of adenomyosis visualised by magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol 2008; 137: 204-209
    CrossrefPubMedGoogle Scholar
  • 30 Marcoux S. R Maheux, S Bérubé Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis N Engl. J Med 1997; 337 (04) 217-222
    PubMedGoogle Scholar
  • 31 Kunz G, Herbertz M, Beil D, Huppert G, Leyendecker G. Adenomyosis as a disorder of the early and late human reproductive period. Reprod Biomed Online 2007; 15: 681-685
    CrossrefPubMedGoogle Scholar
  • 32 Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P. Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Fertil Steril 2006; 86: 711-715
    CrossrefPubMedGoogle Scholar
  • 33 Somigliana E, Vigano P, Barbara G, Vercellini P. Treatment of endometriosis-related pain: options and outcomes. Front Biosci (Elite Ed) 2009; 1: 455-465
    CrossrefPubMedGoogle Scholar
  • 34 Beste MT, Pfaffle-Doyle N, Prentice EA. et al. Molecular Network Analysis of Endometriosis Reveals a Role for c-Jun-Regulated Macrophage Activation. Sci Transl Med. 2014; 6 (222) 222ra216-222ra216
    CrossrefPubMedGoogle Scholar
  • 35 Vlahos N, Vlachos A, Triantafyllidou O, Vitoratos N, Creatsas G. Continuous versus cyclic use of oral contraceptives after surgery for symptomatic endometriosis: a prospective cohort study. Fertil Steril 2013; 100 (05) 1337-1342
    CrossrefPubMedGoogle Scholar
  • 36 Alkatout I, Mettler L, Beteta C. et al. Combined Surgical and Hormone Therapy for Endometriosis is the Most Effective Treatment: Prospective, Randomized, Controlled Trial. J Minim Invasive Gynecol 2013; 20: 473-481
    CrossrefPubMedGoogle Scholar
  • 37 Perello MF, Martinez-Zamora MA, Torres X, Munros J, Balasch Cortina J, Carmona F. Endometriotic Pain Is Associated with Adenomyosis but Not with the Compartments Affected by Deep Infiltrating Endometriosis. Gynecol Obstet Invest 2017; 82 (03) 240-246
    CrossrefPubMedGoogle Scholar
  • 38 Younes G, Tulandi G. Effecto fo adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. Fertil Steril Sep 108:483–490 2017
    PubMedGoogle Scholar