Is prior uterine surgery a risk factor for adenomyosis?

Panganamamula UR, Uma R Panganamamula, Ozgur H Harmanli, Harmanli OH, Isik-Akbay EF, Ebru F Isik-Akbay, Chad A. Grotegut, Grotegut CA, Dandolu V, Vani Dandolu, John P Gaughan, Gaughan JP
Obstetrics and gynecology · 2004 · doi:10.1097/01.AOG.0000143264.59822.73 · PMID:15516398
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This study found that a history of any prior uterine surgery was significantly associated with an increased risk of adenomyosis in women undergoing hysterectomy for benign conditions.

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This retrospective study evaluated whether prior uterine surgery serves as a risk factor for adenomyosis by reviewing medical records of 873 women who underwent hysterectomy for benign conditions. The researchers compared patients with and without adenomyosis regarding their surgical history, including cesarean delivery, myomectomy, and endometrial ablation, while controlling for gravidity and parity. Results indicated that a history of any prior uterine surgery significantly increased the risk of adenomyosis in multivariable analysis, although no specific procedure showed a significant individual association due to small subgroup sizes. This paper is centrally about adenomyosis — specifically investigating the epidemiological link between previous uterine surgeries and the development of this condition.

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Abstract

OBJECTIVE: The objective of our study was to assess whether prior uterine surgery is a risk factor for adenomyosis. METHODS: Medical records of women who had a hysterectomy for benign conditions between January of 1995 and June of 2002 were reviewed. Women with and without adenomyosis were compared with respect to history of prior uterine surgery, such as cesarean delivery, myomectomy, endometrial ablation, dilation and evacuation, and dilation and curettage. RESULTS: Of 873 completed records available, 412 patients (47.1%) had adenomyosis. Mean age and race distribution were similar between the 2 groups. The group with adenomyosis had significantly higher gravidity (P < .001) and parity (P = .004), but smaller uterine size (P < .001) and uterine weight (P < .001). Univariable analysis for each aforementioned specific surgical procedure did not indicate a significant difference between women with and without adenomyosis. However, history of any prior uterine surgery increased the risk of adenomyosis (48.8% and 41.0%, odds ratio 1.37, 95% confidence interval 1.05-1.79) on univariable analysis. This association remained significant when all of the factors were combined in a multivariable logistic regression model. CONCLUSION: In this study, we found a significantly increased risk of adenomyosis with prior uterine surgery. The absence of significant association with any specific surgical procedure is possibly the result of a smaller number of subjects in each individual group. LEVEL OF EVIDENCE: II-3.
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Objective

The objective of our study was to assess whether prior uterine surgery is a risk factor for adenomyosis.

Methods

Medical records of women who had a hysterectomy for benign conditions between January of 1995 and June of 2002 were reviewed. Women with and without adenomyosis were compared with respect to history of prior uterine surgery, such as cesarean delivery, myomectomy, endometrial ablation, dilation and evacuation, and dilation and curettage.

Results

Of 873 completed records available, 412 patients (47.1%) had adenomyosis. Mean age and race distribution were similar between the 2 groups. The group with adenomyosis had significantly higher gravidity (P < .001) and parity (P = .004), but smaller uterine size (P < .001) and uterine weight (P < .001). Univariable analysis for each aforementioned specific surgical procedure did not indicate a significant difference between women with and without adenomyosis. However, history of any prior uterine surgery increased the risk of adenomyosis (48.8% and 41.0%, odds ratio 1.37, 95% confidence interval 1.05–1.79) on univariable analysis. This association remained significant when all of the factors were combined in a multivariable logistic regression model.

Conclusion

In this study, we found a significantly increased risk of adenomyosis with prior uterine surgery. The absence of significant association with any specific surgical procedure is possibly the result of a smaller number of subjects in each individual group. LEVEL OF EVIDENCE: II-3

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Hysterectomy Uterine Diseases Adult Aged Aged, 80 and over Endometriosis Female Humans Logistic Models Middle Aged Multivariate Analysis Retrospective Studies Risk Factors Uterine Diseases Uterine Diseases

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