Merck Manual

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Uterine Adenomyosis


Charlie Kilpatrick

, MD, MEd, Baylor College of Medicine

Reviewed/Revised Feb 2023

Uterine adenomyosis is the presence of endometrial glands and stroma in the uterine musculature. Symptoms include heavy menstrual bleeding, dysmenorrhea, and pelvic pain. Diagnosis is with a pelvic examination that detects a diffusely enlarged uterus and with transvaginal ultrasonography or MRI. Treatment is hormonal medications or hysterectomy.

In uterine adenomyosis, ectopic endometrial tissue infiltrates the myometrium. This 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.

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

  • Pelvic examination

  • Usually ultrasonography or MRI

Uterine adenomyosis is suggested by symptoms and diffuse uterine enlargement seen during a pelvic examination 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 combined estrogen/progestin 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.

Drugs Mentioned In This Article

Drug Name Select Trade
AfterPill, EContra EZ, EContra One-Step, Fallback Solo, Kyleena , LILETTA, Mirena, My Choice, My Way, Next Choice, Next Choice One Dose, Norplant, Opcicon One-Step, Plan B, Plan B One-Step , Preventeza, React, Skyla, Take Action
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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