Adenomyosis: the missed disease.

Area of Science:

• Gynecology
• Reproductive Medicine
• Pathophysiology

Background:

• Adenomyosis is a benign uterine disorder characterized by endometrial stroma and glands within the myometrium.
• Pathogenesis involves genetic/epigenetic factors, hormonal imbalances, immune dysfunction, fibrosis, and neuroangiogenesis.
• Historically diagnosed post-hysterectomy, it's now increasingly identified in younger women and infertile patients.

Purpose of the Study:

• To review the current understanding of adenomyosis, including its pathogenesis, diagnosis, and management.
• To highlight the challenges in diagnosis and the need for standardized management strategies.

Main Methods:

• Review of current literature on adenomyosis.
• Discussion of diagnostic modalities including transvaginal ultrasonography and magnetic resonance imaging.
• Analysis of clinical presentation, co-existing conditions, and management approaches.

Main Results:

• Adenomyosis is increasingly diagnosed in younger women, often presenting with dysmenorrhea, abnormal bleeding, and infertility.
• It frequently coexists with other gynecological conditions like endometriosis and uterine fibroids.
• Despite improved imaging, diagnosis remains challenging due to varied presentations and imaging criteria, leading to delayed or missed diagnoses.

Conclusions:

• Adenomyosis requires a lifelong management plan focusing on symptom control, fertility preservation, and managing pregnancy complications.
• Improved awareness and standardized diagnostic and management protocols are essential for optimal patient care.
• Further research is needed to refine diagnostic criteria and therapeutic strategies for adenomyosis.