ADENOMIOSIS UTERINA PDF

Causes[ edit ] The cause of adenomyosis is unknown, although it has been associated with any sort of uterine trauma that may break the barrier between the endometrium and myometrium, known as the junctional zone, such as a caesarean section , surgical pregnancy termination , and any pregnancy. It can be linked with endometriosis , [11] but studies looking into similarities and differences between these two conditions have conflicting results. It is also a matter of discussion whether the link between reproductive disorders and major obstetrical disorders also lies here. Hormonal factors such as local hyperestrogenism and elevated levels of s-prolactin as well as autoimmune factors have also been identified as possible risk factors. At the same time, estrogen treatment will increase uterine peristalsis again, leading to a vicious circle and a chain of biological alterations essential for the development of adenomyosis.

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Despite often marked enlargement of the uterus, the overall contour is usually preserved 5. In some cases, adenomyosis may be localized, forming a mass. In such cases, the term adenomyoma may be used, although there appears to be some disagreement about whether the terms focal adenomyosis and adenomyoma refer to exactly the same entity please refer to the article on adenomyoma for further discussion.

A rare variant is cystic adenomyosis which is believed to be the result of repeated focal hemorrhages resulting in cystic spaces filled with altered blood products 5. Ultrasound Although pelvic ultrasound is the primary imaging modality employed to investigate menorrhagia and dysmenorrhea , the sonographic features are variable and the sensitivity is operator and technique dependent.

Hysterosalpingogram HSG May show diverticula extending into the myometrium 3. CT CT is insensitive for adenomyosis, but may demonstrate resulting uterine enlargement.

Distinguishing adenomyosis and uterine fibroids on CT is challenging, although the presence of calcifications strongly favors the latter 5. Small field of view T2-weighted images sagittal and axial are most useful.

In some instances, suppression of normal cyclical hormone-induced proliferation of endometrial tissue e. GnRH agonist is sufficient. In women with severe symptoms not relieved medically, and in whom fertility is no longer desirable, a hysterectomy may be performed. The modern definition of adenomyosis was thought to have been provided in by Bird et. Differential diagnosis The differential depends on the macroscopic distribution of endometrial tissue. For diffuse disease consider:.

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