Adenomyosis

Adenomyosis is a complex uterine pathology of patients between the ages of 35 and 50 that causes uterine thickening and enlarging. Sometimes it also focally affects young women with adenomyomas. The mechanisms of formation remain unclear, although it has been associated with any sort of uterine trauma that may break the barrier between the endometrium and myometrium, known as the junctional zone. In adenomyosis endometrial epithelial cells and stromal fibroblasts are abnormally detected in the myometrium, where they cause hyperplasia and hypertrophy of surrounding smooth muscle cells. Sometimes adenomyosis can be found together with endometriosis. Parity, age, and previous uterine abrasion increase the risk of adenomyosis. Hormonal factors such as local hyperestrogenism and elevated levels of s-prolactin as well as autoimmune factors have also been identified as possible risk factors. Adenomyosis is currently associated with chronic pelvis pain, abnormal or heavy menstrual bleeding, painful menstruation, painful vaginal intercourse, and pressure on the bladder while clinical signs are uterine enlargement, tender uterus, and infertility or subfertility. Thus, although it is a benign condition, adenomyosis heavily impacts women’s health and fertility. Adenomyosis shows different patterns in the extent and location within the uterus. The diagnosis of adenomyosis is complex and achievable through noninvasive imaging techniques, such as transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI), especially for a presurgical diagnosis. The final diagnosis, following clinical and imaging suspicion, is made by a pathologist through microscopic examination of uterine tissue samples obtained via laparoscopic or laparotomic procedures, uterine biopsy, or directly after hysterectomy. In this chapter, we will discuss the current literature on the pathophysiology, symptomatology, and instrumental evaluation of adenomyosis, as well as the biological mechanisms underlying the clinical findings.