Adenomyosis Clinical Presentation

Updated: Jun 29, 2023
  • Author: Lisa Kirsten Ely, MD; Chief Editor: Nicole W Karjane, MD  more...
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It is important to obtain a full past medical and past surgical history, including the patient’s gynecologic history, current complaints, medications and previous treatments. Patients with adenomyosis commonly report symptoms similar to those reported by patients with endometriosis. Common complaints include menorrhagia, dysmenorrhea, metrorrhagia, chronic pelvic pain and dyspareunia. [13, 19, 20]  Patients often report a history of multiple pregnancies or uterine surgeries. [12]  Infertility is occasionally reported, but its incidence is inconsistent. [21] However, with more women delaying pregnancy until later in life, infertility may become more frequently associated with adenomyosis. [9, 22, 4, 2]


Physical Examination

A full physical examination should be performed. This should include inspection of the perineum, vagina, cervix, and bimanual exam of the uterus and adnexa. The uterine size, shape, mobility and tenderness should be evaluated. A diffusely enlarged, tender, “boggy” uterus is suggestive of adenomyosis. Alternatively, severe endometriosis often presents as a fixed, tender uterus, with palpable nodules within the posterior cul-de-sac and/or lining the uterosacral ligaments and rectovaginal septum. [23, 5]