Differences in the clinical phenotype of adenomyosis and leiomyomas: a retrospective, questionnaire-based study

Purpose To compare women undergoing laparoscopic hysterectomy with adenomyosis and women with leiomyomas.

Retrospective and questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University Women’s Clinic, Tuebingen, Germany. The study sample comprised a total of 454 women who underwent hysterectomy for adenomyosis or leiomyomas and responded to the questionnaire; 52 (11.4 %) women with a histologic diagnosis of adenomyosis and 452 (88.6 %) women with a histologic diagnosis of leiomyomas.

Both groups of patients had enlarged uteri, but women with adenomyosis had a lower mean uterine weight as compared to women with leiomyomas (p < 0.001). Women with adenomyosis had significantly more pregnancies (p = 0.003), were more likely to have more than one pregnancy (p = 0.033) or more than one delivery (p = 0.025) as compared to women with leiomyomas. In addition, women with adenomyosis had a significantly higher surgical procedure score (p = 0.017), had more frequently a history of laparotomy (p = 0.042) and a history of Cesarean section as compared to women with leiomyomas only (p = 0.024). Significantly, more women with adenomyosis had pelvic pain or pressure as compared to women with leiomyomas (p = 0.045). We observed no differences between the two groups of patients regarding pelvic pain during the menstrual period, irregular menstrual periods, heavy bleeding, painful sexual intercourse and urination problems. Furthermore, we observed no differences in the therapeutic impact of the surgical procedure between the two patient groups.

Women with a histologic diagnosis of adenomyosis differ from women who have only leiomyomas at the time of hysterectomy. Similar content being viewed by others Change history 28 August 2019 In the Original article publication, the name of the co-author Antje Ganz was not included. The Correct order of authors is as given above.

Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4(4):312–322 Azziz R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 16(1):221–235 Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB (2001) Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 16(11):2418–2421 Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM (2009) Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the study of women’s health across the nation (SWAN). Fertil Steril 91(1):201–206 Leyendecker G, Wildt L, Mall G (2009) The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 280:529–538 Walker CL, Stewart EA (2005) Uterine fibroids: the elephant in the room. Science 308(5728):1589–1592 Cong RJ, Huang ZY, Cong L, Ye Y, Wang Z, Zha L, Cao LP, Su XW, Yan J, Li YB (2012) Polymorphisms in genes HSD17B1 and HSD17B2 and uterine leiomyoma risk in Chinese women. Arch Gynecol Obstet 286:701–705 Fernandez H, Farrugia M, Jones SE, Mauskopf JA, Oppelt P, Subramanian D (2009) Rate, type, and cost of invasive interventions for uterine myomas in Germany, France, and England. J Minim Invasive Gynecol 16(1):40–46 Brill AI (2009) Treatment of fibroids via uterine artery occlusion (uterine artery embolization and Doppler-guided uterine artery occlusion): potential role in today’s armamentarium. Arch Gynecol Obstet 280:513–520 Stewart EA (2001) Uterine fibroids. Lancet 357(9252):293–298 Vercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani PG (1995) Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod 10(5):1160–1162 Vavilis D, Agorastos T, Tzafetas J, Loufopoulos A, Vakiani M, Constantinidis T, Patsiaoura K, Bontis J (1997) Adenomyosis at hysterectomy: prevalence and relationship to operative findings and reproductive and menstrual factors. Clin Exp Obstet Gynecol 24(1):36–38 Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG (1997) Risk factors for adenomyosis. Hum Reprod 12(6):1275–1279 Parazzini F, Mais V, Cipriani S, Busacca M, Venturini P (2009) Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur J Obstet Gynecol Reprod Biol 143(2):103–106 Taran FA, Weaver AL, Coddington CC, Stewart EA (2010) Understanding adenomyosis: a case control study. Fertil Steril 94(4):1223–1228 Taran FA, Weaver AL, Coddington CC, Stewart EA (2010) Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod 25(5):1177–1182 Taran FA, Wallwiener M, Kabashi D, Rothmund R, Rall K, Kraemer B, Brucker SY (2012) Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet 285(6):1571–1576 Wallwiener M, Taran FA, Rothmund R, Kasperkowiak A, Auwarter G, Ganz A, Kraemer B, Abele H, Schonfisch B, Isaacson KB, Brucker SY (2013) Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations. Arch Gynecol Obstet. doi:10.1007/s00404-013-2921-x Boosz A, Lermann J, Mehlhorn G, Loehberg C, Renner SP, Thiel FC, Schrauder M, Beckmann MW, Mueller A (2011) Comparison of re-operation rates and complication rates after total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH). Eur J Obstet Gynecol Reprod Biol 158(2):269–273 Levgur M, Abadi MA, Tucker A (2000) Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol 95(5):688–691 Panganamamula UR, Harmanli OH, Isik-Akbay EF, Grotegut CA, Dandolu V, Gaughan JP (2004) Is prior uterine surgery a risk factor for adenomyosis? Obstet Gynecol 104(5 Pt 1):1034–1038 Vercellini P, Vigano P, Somigliana E, Daguati R, Abbiati A, Fedele L (2006) Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 20(4):465–477 Lu HF, Sheu BC, Shih JC, Chang YL, Torng PL, Huang SC (1997) Intramural ectopic pregnancy. Sonographic picture and its relation with adenomyosis. Acta Obstet Gynecol Scand 76(9):886–889 Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99(2):290–300 Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, Semelka RC, Kowalik A, Armao D, Davis B, Baird DD (2008) Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci USA 105(50):19887–19892 Conflict of interest We declare that we have no conflict of interest. Author information Authors and Affiliations Corresponding author Additional information B. Boeer and M. Wallwiener have contributed equally to this work. Rights and permissions About this article Cite this article Boeer, B., Wallwiener, M., Rom, J. et al. Differences in the clinical phenotype of adenomyosis and leiomyomas: a retrospective, questionnaire-based study. Arch Gynecol Obstet 289, 1235–1239 (2014). https://doi.org/10.1007/s00404-013-3141-0 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-013-3141-0