Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis

Gordts S, Stephan Gordts, Grigoris Grimbizis, Grimbizis G, Campo R, Rudi Campo
Fertility and sterility · 2018 · vol. 109(3) , pp. 380–388.e1 · doi:10.1016/j.fertnstert.2018.01.006 · PMID:29566850 · W2791240641
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This paper reviews the symptoms and classification of uterine adenomyosis and discusses the diagnostic role of hysteroscopy.

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Abstract

Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Hysteroscopy Uterine Diseases Uterus Adenomyosis Adenomyosis Adenomyosis Adenomyosis Female Humans Predictive Value of Tests Prognosis Reproducibility of Results Ultrasonography Uterine Diseases Uterine Diseases Uterine Diseases Uterine Diseases Uterus Uterus

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