Adenomyosis incidence, prevalence and treatment: United States population-based study 2006–2015

Abstract

BACKGROUND: Adenomyosis symptoms are disabling. Populationbased data on incidence and prevalence of adenomyosis are lacking that could guide future evidence-based treatments and clinical management. OBJECTIVE: To evaluate the incidence, 10-year secular trends, and prevalence of adenomyosis diagnoses and to describe symptoms and treatment patterns in a large U.S. cohort. STUDY DESIGN: We performed a retrospective population-based cohort study of women aged 16e60 years in 2006e2015, enrolled in Kaiser Permanente Washington, a mixed-model health insurance and care delivery system. Adenomyosis diagnoses identified by ICD codes from the International Classification of Diseases 9th and 10th editions and potential covariates were extracted from computerized databases. Women with prior hysterectomy, and for incidence estimates women with prior adenomyosis diagnoses, were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression. Rates and trend tests were examined for all women adjusting for age using direct standardization to the 2015 study population, by age groups, and by race/ethnicity. Chart reviews were performed to validate diagnostic accuracy of ICD codes in identifying adenomyosis incidence. Symptoms and treatment patterns at diagnosis and in the following 5 years were assessed. RESULTS: A total of 333,693 women contributed 1,185,855 woman-years (2006e2015) for incidence calculations. Associated symptom-related codes (menorrhagia or abnormal uterine bleeding, dysmenorrhea or pelvic pain, dyspareunia, and infertility) were observed in 90.8%; 18.0% had co-occurrent endometriosis codes and 47.6% had cooccurrent uterine fibroid codes. The overall adenomyosis incidence was 1.03% or 28.9 per 10,000 woman-years, with a high of 30.6 in 2007 and a low of 24.4 in 2014. Overall age-adjusted estimated incidence rates declined during the 10-year study interval (linear trend P < .05). Incidence was highest for women aged 41e45 years (69.1 per 10,000 womanyears in 2008) and was higher for black (highest 44.6 per 10,000 woman-years in 2011) vs white women (highest 27.9 per 10,000 womanyears in 2010). Overall prevalence in 2015 was 0.8% and was highest among women aged 41e45 years (1.5%). Among the 624 potential adenomyosis cases identified by diagnostic codes in 2012e2015 and with sufficient information in the medical record to determine true case status, 490 were confirmed as incident cases, yielding a 78.5% (95% confidence interval, 75.1%, 81.7%) positive predictive value of adenomyosis ICD-9/ICD-10 codes for identifying an incident adenomyosis case. Health care burden was substantial: 82.0% of women had hysterectomies, nearly 70% had imaging studies suggestive of adenomyosis, and 37.6% used chronic pain medications. CONCLUSION: Adenomyosis burden to the individual and the health care system is high. Incidence rates are disproportionately high among black women. These findings are of concern, as currently available longterm medical therapies remain limited beyond hysterec...

Prevalence of Adenomyosis in Hysterectomy Specimens Performed at a Tertiary Hospital of Kathmandu, Nepal

“…The age group for adenomyosis ranged from 36-52 years with mean age of 44 ± 4.4 which is almost similar to the mean age in a study done by Tahlan et al 9 , Yu et al 11 and Taran et al 12 .…”

Adenomyosis: Mechanisms and Pathogenesis

“…In addition to a central role for local hyperestrogenism, progesterone resistance, and inflammation in the pathogenesis of adenomyosis, these factors along with abnormal uterine contrac-tility, neurogenesis, and neoangiogenesis are key pathogenic mediators of the pain, HMB, and infertility experienced by women with adenomyosis. Two other common disorders of the uterus, endometriosis, and uterine fibroids are also estrogen dependent and, like adenomyosis, have accompanying symptoms of dysmenorrhea, pelvic pain, abnormal uterine bleeding, and infertility, and they often coexist (18% of women with adenomyosis had concurrent endometriosis and 47% had uterine fibroids, based on hospital codes 170 ). Despite these similarities, the underlying pathogenesis, pathophysiology, risk factors, and therapies for these conditions mostly differ and warrant further comparative study.…”

Epidemiology of Adenomyosis

“…The other study used electronic health care data from a large U.S. health insurance and care delivery system in western Washington state. 75 The study cohort comprised women aged 16 to 60 years who were enrolled in the integrated health care system for at least 2 years, had at least one health visit, and did not have a record of hysterectomy in the two preceding months nor diagnosis of adenomyosis 2 years before cohort entry (January 1, 2006, through December 31, 2015). Incident adenomyosis cases were identified using the International Classification of Diseases 9th or 10th revision codes (617.0 and N80.0, respectively) from either an inpatient stay or outpatient visit.…”

“…The estimated prevalence in year 2015 was 0.8%. 75 Using these methods, the incidence of adenomyosis is likely underestimated. The extent of the underestimation is unknown given the inconsistent histologic and imaging diagnostic standards, reliance primarily on diagnosis at hysterectomy, and lack of screening for adenomyosis in the general population.…”