Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

Abstract

Background:Adenomyosis is a gynecological disorder with symptoms most presenting as dysmenorrhea and heavy menstrual bleeding. However, the presence of lower urinary tract symptoms (LUTS) among women with adenomyosis remains unclear. This study was designed to determine the prevalence of LUTS and factors related to the severity of these symptoms in this population.Methods:From July 2016 to November 2016, a total of 298 untreated symptomatic adenomyosis patients and 280 age-matched controls were enrolled. Demographics, LUTS, pain symptoms, ultrasonographic uterine size, and serum CA125 level were recorded. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire. Factors related to the severity of LUTS were detected using the logistic regression analysis presented as odds ratio (OR) and 95% confidence interval (CI).Results:Compared with the control group, patients with adenomyosis had a greater IPSS total (4 [2–8] vs. 2 [0–3], Z = –8.159, P < 0.001), IPSS storage (2 [1–4] vs. 1[0–2], Z = –7.361 P < 0.001), and IPSS voiding (2 [0–4] vs. 0 [0–1], Z = –7.194, P < 0.001). Of the patients with adenomyosis, 30.2% had moderate-to-severe lower urinary tract symptoms (IPSS ≥8). The most prevalent LUTS were daytime frequency (40.9%), followed by nocturia (24.8%), weak stream (24.2%), and incomplete emptying (23.5%). In study group, patients with an IPSS total score ≥8 had higher proportion of menorrhagia (51.1% vs. 30.8%, χ2 = 11.162 P = 0.025) and larger uterine volumes (183.3 [109.8–273.8] cm3 vs. 148.5 [96.4–262.7] cm3, Z = –1.441, P = 0.150) compared to patients with an IPSS total score <8. On multivariate logistic regression analysis, patients with menorrhagia were associated with an increased risk of an IPSS total score ≥8 (OR: 2.309, 95% CI: 1.310–4.070, P = 0.004), an IPSS storage subscore ≥4 (OR: 2.422, 95% CI: 1.395–4.206, P = 0.002), and an IPSS voiding subscore ≥5 (OR: 1.971, 95% CI: 1.176–3.302, P = 0.010). However, patients with uterine volume more than 180 cm3 had more than 2-fold risk of bearing IPSS total score ≥8 (OR: 2.437, 95% CI: 1.381–4.300, P = 0.002), IPSS storage subscore ≥4 (OR: 2.486, 95% CI: 1.433–4.314, P = 0.001), and IPSS voiding subscore ≥5 (OR: 2.700, 95% CI: 1.485–4.908, P = 0.001).Conclusions:Lower urinary tract symptoms are prevalent in patients with symptomatic adenomyosis and greatly affect patients’ quality of life. Menorrhagia and large uterine volume could be potential risk factors that increase the occurrence of moderate-to-severe LUTS.

Efficacy of hormonal therapies for decreasing uterine volume in patients with adenomyosis

“…As previously mentioned, severely increased uterine volume causes abdominal discomfort, with symptoms including flatulence, distended abdomen, and lower urinary tract symptoms with adenomyosis. [ 3 ] Furthermore, a larger uterus may lead to DVT. When surgical intervention is necessary, total laparoscopic hysterectomy (TLH) is the preferred surgical treatment, and it has been found that reducing the uterine volume can expand the indications for and reduce the difficulty of TLH.…”

“…It was reported that a large uterine volume could be a potential risk factor for an increase in the occurrence of moderate-to-severe lower urinary tract symptoms with adenomyosis. [ 3 ] It was also reported that larger tumors were more often complicated by deep venous thrombosis (DVT) in patients with uterine fibroids. [ 4 ] In our experience, a large uterus due to adenomyosis may lead to DVT.…”

Classifications of Adenomyosis and Correlation of Phenotypes in Imaging and Histopathology to Clinical Outcomes: a Review

“…Another feature associated with adenomyosis, and indirectly, with disease volume, is uterine volume. Li et al showed that large uterine size was independently associated with bothersome lower urinary tract symptoms (LUTS) and HMB, but not dysmenorrhea or chronic pelvic pain (CPP) [50]. Another group showed that smaller uteri were associated with more CPP (8).…”

Development of a clinical prediction model for diagnosing adenomyosis

“…About a third of women with adenomyosis exhibit lower urinary tract symptoms, like pollakiuria, nocturia or dysuria, and those symptoms are positively correlated to an enlarged uterus and menorrhagia (43,44). Urinary incontinence (both urge and stress incontinence) are also associated with adenomyosis, with a prevalence of 26% amongst women with adenomyosis (44).…”