In adenomyosis, the ectopic endometrial tissue tends to induce diffuse uterine enlargement (globular uterine enlargement). The uterus may double or triple in size but typically does not exceed the size of a uterus at 12 weeks' gestation.
True prevalence is unknown, partly because making the diagnosis is difficult. However, adenomyosis is most often detected incidentally in women who are being evaluated for endometriosis Endometriosis In endometriosis, functioning endometrial cells are implanted in the pelvis outside the uterine cavity. Symptoms depend on location of the implants. The classic triad of symptoms is dysmenorrhea... read more , fibroids Uterine Fibroids Uterine fibroids are benign uterine tumors of smooth muscle origin. Fibroids frequently cause abnormal uterine bleeding, pelvic pain and pressure, urinary and intestinal symptoms, and pregnancy... read more 
, or pelvic pain Female Pelvic Pain Pelvic pain is discomfort in the lower abdomen and is a common complaint. It is considered separately from vaginal pain and from vulvar or perineal pain, which occurs in the external genitals... read more . Higher parity increases risk.
Symptoms and Signs of Uterine Adenomyosis
Common symptoms of uterine adenomyosis are heavy menstrual bleeding, dysmenorrhea, and anemia. Chronic pelvic pain may also be present.
Symptoms may resolve after menopause.
Diagnosis of Uterine Adenomyosis
Usually ultrasonography or MRI
Uterine adenomyosis is suggested by symptoms and diffuse uterine enlargement in patients without endometriosis or fibroids. Transvaginal ultrasonography and MRI are commonly used for diagnosis, although definitive diagnosis requires histology after hysterectomy.
Treatment of Uterine Adenomyosis
Hysterectomy
The most effective treatment for uterine adenomyosis is hysterectomy.
Hormonal treatments similar to those used to treat endometriosis Drug therapy In endometriosis, functioning endometrial cells are implanted in the pelvis outside the uterine cavity. Symptoms depend on location of the implants. The classic triad of symptoms is dysmenorrhea... read more may be tried. Treatment with oral contraceptives can be tried but is usually unsuccessful. A levonorgestrel-releasing intrauterine device (IUD) may help control dysmenorrhea and bleeding.
Key Points
In uterine adenomyosis, the uterus may double or triple in size.
It commonly causes heavy menstrual bleeding, dysmenorrhea, and anemia and may cause chronic pelvic pain; symptoms may resolve after menopause.
Diagnose by transvaginal ultrasonography and/or MRI; however, definitive diagnosis requires histology after hysterectomy.
The most effective treatment is hysterectomy, but hormonal treatments (eg, oral contraceptives) can be tried.
