Risk factors for adenomyosis

Abstract

In order to analyse risk factors for adenomyosis, 707 consecutive women who underwent hysterectomy between January 1993 and June 1994 at the Clinica Luigi Mangiagalli, Milan, Italy, were interviewed before surgery by trained physicians. Information on the presence of adenomyosis was obtained from pathologic records. Out of the 707 women, adenomyosis was identified in 150 subjects (21.2%). Women who smoked tended to be at decreased risk of the condition: in comparison with women who had never smoked, the risk for current smokers was 0.7 (0.3-1.3) and the risk decreased with number of cigarettes smoked per day, the odds ratios being 0.8 and 0.6 respectively in women reporting fewer than 10 and more than 10 cigarette smoked per day (chi2 trend 3.57, P = 0.06). The frequency of adenomyosis was higher in parous women: in comparison with nulliparae, the odds ratio of the disease were 1.8 [95% confidence interval (CI) 0.9-3.4] and 3.1 (95% CI 1.7-5.5) respectively in women reporting one and two or more births (chi2 trend 20.71, P < 0.01). Likewise, women reporting one or more spontaneous abortions had an odds ratio of 1.7 (95% CI 1.1-2.6) for adenomyosis, in comparison with those reporting no spontaneous abortion.

Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN)

“…The preoperative diagnosis of endometriosis based on prior observations was made 4 times, twice in patients with adenomyosis and twice without adenomyosis. Three prior controlled studies reported prevalence of endometriosis between 5-10% in specimens with adenomyosis and 7-8% without adenomyosis (13,15,16). These differences were not statistically significant.…”

“…In hysterectomy specimens the incidence of adenomyosis reported in the literature varies, ranging from a high of 61.5% to a low of 8.8% (2,5,(11)(12)(13)(14)(15). Hyperestrogenemia, a cause of endometrial hyperplasia and fibroid growth, has been associated with adenomyosis, (5,11) as has prior pregnancy (2,3,13,15,16). Adenomyosis has also been related to the presence of endometriosis (2,(17)(18)(19).…”

“…When present, these symptoms lead to a presumptive preoperative diagnosis of adenomyosis, and are often used as an indication for hysterectomy. While some have suggested that adenomyosis is associated with these symptoms (1)(2)(3)(4)(5)(20)(21)(22) and more commonly coexists with fibroids (2) and endometriosis (2,(17)(18)(19) others have concluded the opposite view (3,(11)(12)(13)(14)(15)(16). It is apparent that these issues need further clarification.…”

A retrospective study of the clinical features of 50 consecutive cases diagnosed to have adenomyosis by histopathology in hysterectomy specimens in a tertiary centre

“…7 The main symptoms are menorrhagia (40-60%) dysmenorrhea (10-30%) and metrorrhagia (10-12%). 8,9 Menorrhagia possibly results from increased and abnormal vascularisation of the endometrial lining 1 . Dysmenorrhea is thought to be due to increased prostaglandin production found in adenomyotic tissue.…”

Preterm delivery in a primigravida with uterine adenomyosis

“…1,2 Several previous studies were reported that the risk of adenomyosis was increased after spontaneous abortions and dilation and curettage. 3,4 Uterine adenomyosis most commonly occurs in multiparous women in their late 30s or 40s, but rare in nulligravid women. Uterine adenomyosis can be classified into two categories: focal adenomyosis with lesions localized in the anterior or posterior wall; and diffuse adenomyosis with lesions in the entire uterus.…”