Adenomyosis: current perspectives

Adenomyosis frequently involves gravid and nongravid uteri, remaining asymptomatic in up to one half of all cases. The symptoms of adenomyosis, particularly menorrhagia and dysmenorrhea, correlated with the depth of myometrial involvement, and consequently with the patient's age. Adenomyosis is most frequent in parous women in their middle to late forties. There is a high frequency of associated pathology, including leiomyomas, endometriosis, endometrial hyperplasia, and carcinoma. This relationship may suggest a common underlying disorder, such as hyperestrogenemia. Adenomyosis is a frequent finding in pregnancy, and obstetric or surgical complications are rare. Approximately 30 to 50 per cent of adenomyotic foci respond to progesterone, particularly to the high serum levels in pregnancy. The preoperative diagnosis of adenomyosis remains poor. Radiologic procedures and serum levels of CA-125 are of limited diagnostic value. Only a high degree of clinical suspicion will aid in the diagnosis of this histopathologic entity. Hysterectomy remains the mainstay of treatment and diagnosis.