Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis

Abstract

Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound. (Fertil Steril Ò 2018;109:380-8. Ó2018 by American Society for Reproductive Medicine.

Gynecological associated disorders and management

“…Transvaginal ultrasound is useful in detecting the presence of pelvic pathologies such as endometrioma, adenomyosis or hydrosalpinx . Pelvic MRI can be used as an adjunct to ultrasound in evaluation of pelvic pathologies …”

“…[14][15][16] Pelvic MRI can be used as an adjunct to ultrasound in evaluation of pelvic pathologies. [17][18][19] In patients with undiagnosed CPP after a complete evaluation including history, physical examination, relevant laboratory testing and imaging studies, diagnostic laparoscopy can be considered. The most common finding on laparoscopy in patients with CPP is adhesions, followed by endometriosis.…”

The Pathogenesis of Adenomyosis vis-à-vis Endometriosis

“…Adenomyosis, defined as the presence of endometrial glands and stroma infiltrated deep and haphazardly into the myometrium [1], is a common gynecologic disorder with poorly understood pathogenesis and pathophysiology [2][3][4]. Its presenting symptoms include a soft and diffusely enlarged uterus with pelvic pain, abnormal uterine bleeding (AUB), and subfertility [5][6][7][8].…”

Modern possibilities for the diagnosis of adenomyosis

“…диагностика основана на клинической картине и данных, полученных с помощью неинвазивных методов обследования [10]. К клиническим проявлениям аденомиоза относят различные варианты аномальных маточных кровотече-ний, болевой синдром, диспареунию, приводящие к достоверному снижению качества жизни [11][12][13][14][15]. Последние исследования показали, что аденомиозу подвержены и молодые женщины, у которых заболевание ассоциировано с бесплодием и невынашиванием беременности [13,16,17].…”

“…в настоящее время многие исследователи сходятся во мнении о необходимости создания единой систематической классификации аденомиоза, в том числе с помощью различных методов визуализации [12][13][14]. Поиск новых патогенетических механизмов развития заболевания с целью прогнозирования темпов, характера и выраженности клинических проявлений представляет научный и практический интерес.…”