New knowledge about adenomyosis

This chapter discusses the diagnosis, molecular aspects of adenomyosis, its contributions to pain and infertility and poor pregnancy outcomes, and medical and surgical therapeutic options. Over the past 25 years, the diagnosis of adenomyosis has been revolutionized by the noninvasive techniques of magnetic resonance imaging (MRI) and transvaginal sonography (TVS), which rely on careful evaluation of the inner myometrial layer. Aberrant peristalsis may induce adenomyosis by producing microtraumas at the endometrial-myometrial interface, with the activation of the mechanism of tissue repair in a self-perpetuating cycle. There is evidence of increased invasiveness of endometrial cells in adenomyosis, as well as in endometriosis. In a study of the clinical characteristics associated with a postoperative diagnosis of adenomyosis, or with the combined association of adenomyosis and fibroids, Jean-Baptiste reported that dysmenorrhea was the only variable significantly associated with adenomyosis. Adenomyosis diagnosed at hysterectomy has traditionally been linked to multiparity, pregnancy termination, and uterine curettage, especially after pregnancy.