Fibroid-like Conditions: Adenomyosis and Endometrial Polyps

Adenomyosis

Definition, prevalence and causes

Adenomyosis is a benign disease of the uterus in which tissues that are usually limited to the endometrium (inner lining of the uterus) are found within the myometrium (the muscular layer of the uterus). Adenomyosis most commonly affects women between the ages of 40 and 50 years and is associated with a past history of childbirth. Approximately 80 percent of women with this disorder have given birth.

Adenomyosis is also associated with other uterine disorders. More than 80 percent of women with adenomyosis have another abnormal condition in the uterus; 50 percent of patients have associated fibroids (benign smooth muscle tumors of the uterus), approximately 11 percent have endometriosis (endometrial tissue outside of the uterus, most commonly in the ovaries), and seven percent have endometrial polyps (benign outgrowths of endometrial tissue). The symptoms of these associated conditions often make it difficult diagnose adenomyosis.

Symptoms and diagnosis

A typical uterus with adenomyosis is bloated and enlarged. Symptoms of adenomyosis include abnormal uterine bleeding and pelvic pain. Approximately 60 percent of women with adenomyosis experience abnormal uterine bleeding , and 25 percent experience dysmenorrhea (pelvic pain during menstruation).

The diagnosis can be made only by microscopic examination of uterine tissue specimens obtained during surgery. Pelvic ultrasound or pelvic MRI may suggest the condition but it cannot positively diagnose it.

Treatment

The only definitive treatment for adenomyosis is total hysterectomy (surgical removal of the entire uterus). GnRH (gonadotropin releasing hormone) agonists have been used in a few cases, resulting in a temporary decrease in uterine size, in amenorrhea (cessation of menstrual cycling), and even in the ability to conceive. Unfortunately, regrowth of the adenomyosis and recurrence of symptoms usually occur within six months of stopping GnRH treatment.

Endometrial Polyps

Definition and prevalence

Endometrial polyps are excess outgrowths of the endometrium (innermost uterine layer) in the uterine cavity. Polyps rarely in benign or malignant growths.

The prevalence of polyps is estimated to be 10 percent to 24 percent of women undergoing hysterectomy (surgical removal of the uterus) or localized endometrial biopsy. Endometrial polyps are rare among women younger than 20 years of age. The incidence of these polyps rises steadily with increasing age, peaking in the fifth decade of life, and gradually declining after menopause.

Symptoms and Diagnosis

The most frequent symptom of women with endometrial polyps is metrorrhagia (irregular, acyclic uterine bleeding), which is reported in 50 percent of symptomatic cases. Post-menstrual spotting is also common. Less frequent symptoms include heavy menstrual bleeding, post-menopausal bleeding, and breakthrough bleeding during hormonal therapy. Overall, endometrial polyps account for 25 percent of abnormal bleeding in both premenopausal and postmenopausal women.

Endometrial polyps are often diagnosed by microscopic examination of a specimen obtained after endometrial biopsy or after D&C (dilation and curettage) but can also be diagnosed on ultrasound or hysteroscopy.

Treatment

The majority of cases of endometrial polyps are cured by thorough curettage. However, removal of polyps or other structural abnormalities may be missed by blind curettage, therefore, hysteroscopic-guided resection is often useful.

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