Adenomyosis Clinical Presentation

1. Jimenez-Ayala M., Jimenez-Ayala Portillo B., Iglesias Goy, E., Rios Vallejo, M. Cytology of the Normal Endometrium- Cycling and Postmenopausal. Endometrial Adenocarcinoma: Prevention and Early Diagnosis. Switzerland: Karger; 2008.

2. Bergeron C, Amant F, Ferenczy A. Pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006 Aug. 20 (4):511-21. [QxMD MEDLINE Link].

3. Pelvic Mass. Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology. Third. New York, NY: McGraw-Hill;

4. Devlieger R, D'Hooghe T, Timmerman D. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 2003 Mar-Apr. 9 (2):139-47. [QxMD MEDLINE Link].

5. Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update. 1998 Jul-Aug. 4 (4):312-22. [QxMD MEDLINE Link].

6. Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet. 2009 Oct. 280 (4):529-38. [QxMD MEDLINE Link].

7. Yamamoto T, Noguchi T, Tamura T, Kitawaki J, Okada H. Evidence for estrogen synthesis in adenomyotic tissues. Am J Obstet Gynecol. 1993 Sep. 169 (3):734-8. [QxMD MEDLINE Link].

8. Morassutto C, Monasta L, Ricci G, Barbone F, Ronfani L. Incidence and Estimated Prevalence of Endometriosis and Adenomyosis in Northeast Italy: A Data Linkage Study. PLoS One. 2016. 11 (4):e0154227. [QxMD MEDLINE Link].

9. Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd. 2013 Sep. 73 (9):924-931. [QxMD MEDLINE Link].

10. Vercellini P, Viganò P, Somigliana E, Daguati R, Abbiati A, Fedele L. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol. 2006 Aug. 20 (4):465-77. [QxMD MEDLINE Link].

11. Benagiano G, Brosens I, Habiba M. Adenomyosis: a life-cycle approach. Reprod Biomed Online. 2015 Mar. 30 (3):220-32. [QxMD MEDLINE Link].

12. Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG. Risk factors for adenomyosis. Hum Reprod. 1997 Jun. 12 (6):1275-9. [QxMD MEDLINE Link].

13. Genc M, Genc B, Cengiz H. Adenomyosis and accompanying gynecological pathologies. Arch Gynecol Obstet. 2015 Apr. 291 (4):877-81. [QxMD MEDLINE Link].

14. Curtis KM, Hillis SD, Marchbanks PA, Peterson HB. Disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis. Am J Obstet Gynecol. 2002 Sep. 187 (3):543-4. [QxMD MEDLINE Link].

15. Vercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani PG. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod. 1995 May. 10 (5):1160-2. [QxMD MEDLINE Link].

16. Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand. 2017 Jun. 96 (6):715-726. [QxMD MEDLINE Link].

17. Parazzini F, Mais V, Cipriani S, Busacca M, Venturini P, GISE. Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur J Obstet Gynecol Reprod Biol. 2009 Apr. 143 (2):103-6. [QxMD MEDLINE Link].

18. Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001 Nov. 16 (11):2418-21. [QxMD MEDLINE Link].

19. Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014 May. 29 (5):964-77. [QxMD MEDLINE Link].

20. Basak S, Saha A. Adenomyosis: still largely under-diagnosed. J Obstet Gynaecol. 2009 Aug. 29 (6):533-5. [QxMD MEDLINE Link].

21. Alabiso G, Alio L, Arena S, Barbasetti di Prun A, Bergamini V, Berlanda N, et al. Adenomyosis: What the Patient Needs. J Minim Invasive Gynecol. 2016 May-Jun. 23 (4):476-88. [QxMD MEDLINE Link].

22. Vercellini P, Ragni G, Trespidi L, Oldani S, Panazza S, Crosignani PG. Adenomyosis: a déjà vu?. Obstet Gynecol Surv. 1993 Dec. 48 (12):789-94. [QxMD MEDLINE Link].

23. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012 Jul. 120 (1):197-206. [QxMD MEDLINE Link].

24. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol. 2007 Dec. 19 (6):505-12. [QxMD MEDLINE Link].

25. Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. 2001 Nov. 16 (11):2427-33. [QxMD MEDLINE Link].

26. Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010 Nov. 89 (11):1374-84. [QxMD MEDLINE Link].

27. Nam JH, Lyu GS. Abdominal ultrasound-guided transvaginal myometrial core needle biopsy for the definitive diagnosis of suspected adenomyosis in 1032 patients: a retrospective study. J Minim Invasive Gynecol. 2015 Mar-Apr. 22 (3):395-402. [QxMD MEDLINE Link].

28. Dueholm M, Lundorf E, Hansen ES, Sørensen JS, Ledertoug S, Olesen F. Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril. 2001 Sep. 76 (3):588-94. [QxMD MEDLINE Link].

29. Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, et al. Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology. 1996 Apr. 199 (1):151-8. [QxMD MEDLINE Link].

30. Novellas S, Chassang M, Delotte J, Toullalan O, Chevallier A, Bouaziz J, et al. MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol. 2011 May. 196 (5):1206-13. [QxMD MEDLINE Link].

31. Molinas CR, Campo R. Office hysteroscopy and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006 Aug. 20 (4):557-67. [QxMD MEDLINE Link].

32. Keckstein J. Hysteroscopy and adenomyosis. Contrib Gynecol Obstet. 2000. 20:41-50. [QxMD MEDLINE Link].

33. Vercellini P, Trespidi L, Panazza S, Bramante T, Mauro F, Crosignani PG. Laparoscopic uterine biopsy for diagnosing diffuse adenomyosis. J Reprod Med. 1996 Apr. 41 (4):220-4. [QxMD MEDLINE Link].

34. Jeng CJ, Huang SH, Shen J, Chou CS, Tzeng CR. Laparoscopy-guided myometrial biopsy in the definite diagnosis of diffuse adenomyosis. Hum Reprod. 2007 Jul. 22 (7):2016-9. [QxMD MEDLINE Link].

35. Siegler AM, Camilien L. Adenomyosis. J Reprod Med. 1994 Nov. 39 (11):841-53. [QxMD MEDLINE Link].

36. Hulka CA, Hall DA, McCarthy K, Simeone J. Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease?. AJR Am J Roentgenol. 2002 Aug. 179 (2):379-83. [QxMD MEDLINE Link].

37. Struble J, Reid S, Bedaiwy MA. Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. J Minim Invasive Gynecol. 2016 Feb 1. 23 (2):164-85. [QxMD MEDLINE Link].

38. Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility. Acta Obstet Gynecol Scand. 2017 Jun. 96 (6):707-714. [QxMD MEDLINE Link].

39. Fukunishi H, Funaki K, Sawada K, Yamaguchi K, Maeda T, Kaji Y. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol. 2008 Sep-Oct. 15 (5):571-9. [QxMD MEDLINE Link].

40. Yoon SW, Kim KA, Cha SH, Kim YM, Lee C, Na YJ, et al. Successful use of magnetic resonance-guided focused ultrasound surgery to relieve symptoms in a patient with symptomatic focal adenomyosis. Fertil Steril. 2008 Nov. 90 (5):2018.e13-5. [QxMD MEDLINE Link].

41. Kim KA, Yoon SW, Lee C, Seong SJ, Yoon BS, Park H. Short-term results of magnetic resonance imaging-guided focused ultrasound surgery for patients with adenomyosis: symptomatic relief and pain reduction. Fertil Steril. 2011 Mar 1. 95 (3):1152-5. [QxMD MEDLINE Link].

42. Kim MD, Kim S, Kim NK, Lee MH, Ahn EH, Kim HJ, et al. Long-term results of uterine artery embolization for symptomatic adenomyosis. AJR Am J Roentgenol. 2007 Jan. 188 (1):176-81. [QxMD MEDLINE Link].

43. Wang S, Meng X, Dong Y. The evaluation of uterine artery embolization as a nonsurgical treatment option for adenomyosis. Int J Gynaecol Obstet. 2016 May. 133 (2):202-5. [QxMD MEDLINE Link].

44. Smeets AJ, Nijenhuis RJ, Boekkooi PF, Vervest HA, van Rooij WJ, Lohle PN. Long-term follow-up of uterine artery embolization for symptomatic adenomyosis. Cardiovasc Intervent Radiol. 2012 Aug. 35 (4):815-9. [QxMD MEDLINE Link].

45. Froeling V, Scheurig-Muenkler C, Hamm B, Kroencke TJ. Uterine artery embolization to treat uterine adenomyosis with or without uterine leiomyomata: results of symptom control and health-related quality of life 40 months after treatment. Cardiovasc Intervent Radiol. 2012 Jun. 35 (3):523-9. [QxMD MEDLINE Link].

46. Chung YJ, Kang SY, Choi MR, Cho HH, Kim JH, Kim MR. Robot-Assisted Laparoscopic Adenomyomectomy for Patients Who Want to Preserve Fertility. Yonsei Med J. 2016 Nov. 57 (6):1531-4. [QxMD MEDLINE Link].

47. Grimbizis GF, Mikos T, Zepiridis L, Theodoridis T, Miliaras D, Tarlatzis BC, et al. Laparoscopic excision of uterine adenomyomas. Fertil Steril. 2008 Apr. 89 (4):953-61. [QxMD MEDLINE Link].

48. Morita M, Asakawa Y, Nakakuma M, Kubo H. Laparoscopic excision of myometrial adenomyomas in patients with adenomyosis uteri and main symptoms of severe dysmenorrhea and hypermenorrhea. J Am Assoc Gynecol Laparosc. 2004 Feb. 11 (1):86-9. [QxMD MEDLINE Link].

49. Sun AJ, Luo M, Wang W, Chen R, Lang JH. Characteristics and efficacy of modified adenomyomectomy in the treatment of uterine adenomyoma. Chin Med J (Engl). 2011 May. 124 (9):1322-6. [QxMD MEDLINE Link].

50. Younes G, Tulandi T. Conservative Surgery for Adenomyosis and Results: A Systematic Review. J Minim Invasive Gynecol. 2017 Jul 21. [QxMD MEDLINE Link].

51. Trabert B, Weiss NS, Rudra CB, Scholes D, Holt VL. A case-control investigation of adenomyosis: impact of control group selection on risk factor strength. Womens Health Issues. 2011 Mar-Apr. 21 (2):160-4. [QxMD MEDLINE Link].

52. Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015 Jul 30. CD001751. [QxMD MEDLINE Link].

53. Garcia L, Isaacson K. Adenomyosis: review of the literature. J Minim Invasive Gynecol. 2011 Jul-Aug. 18 (4):428-37. [QxMD MEDLINE Link].

54. Fedele L, Bianchi S, Frontino G. Hormonal treatments for adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2008 Apr. 22 (2):333-9. [QxMD MEDLINE Link].

55. Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999 Sep. 60 (3):173-5. [QxMD MEDLINE Link].

56. Farquhar C, Brosens I. Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006 Aug. 20 (4):603-16. [QxMD MEDLINE Link].

57. Bragheto AM, Caserta N, Bahamondes L, Petta CA. Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception. 2007 Sep. 76 (3):195-9. [QxMD MEDLINE Link].

58. Cho S, Choi YS, Yun BH, Chon SJ, Jung YS, Kim H, et al. Effects of levonorgestrel-releasing intrauterine system on lymphangiogenesis of adenomyosis. Am J Clin Pathol. 2015 Mar. 143 (3):352-61. [QxMD MEDLINE Link].

59. Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009 Mar. 79 (3):189-93. [QxMD MEDLINE Link].

60. Cho S, Nam A, Kim H, Chay D, Park K, Cho DJ, et al. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. Am J Obstet Gynecol. 2008 Apr. 198 (4):373.e1-7. [QxMD MEDLINE Link].

61. Ozdegirmenci O, Kayikcioglu F, Akgul MA, Kaplan M, Karcaaltincaba M, Haberal A, et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril. 2011 Feb. 95 (2):497-502. [QxMD MEDLINE Link].

62. Li L, Leng JH, Dai Y, Zhang JJ, Jia SZ, Li XY, et al. [A prospective cohort study on effects of levonorgestrel-releasing intrauterine system for adenomyosis with severe dysmenorrhea]. Zhonghua Fu Chan Ke Za Zhi. 2016 May 25. 51 (5):345-51. [QxMD MEDLINE Link].

63. Streuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C. An update on the pharmacological management of adenomyosis. Expert Opin Pharmacother. 2014 Nov. 15 (16):2347-60. [QxMD MEDLINE Link].

64. Khan KN, Kitajima M, Hiraki K, Fujishita A, Sekine I, Ishimaru T, et al. Changes in tissue inflammation, angiogenesis and apoptosis in endometriosis, adenomyosis and uterine myoma after GnRH agonist therapy. Hum Reprod. 2010 Mar. 25 (3):642-53. [QxMD MEDLINE Link].

65. Huang FJ, Kung FT, Chang SY, Hsu TY. Effects of short-course buserelin therapy on adenomyosis. A report of two cases. J Reprod Med. 1999 Aug. 44 (8):741-4. [QxMD MEDLINE Link].

66. Akira S, Iwasaki N, Ichikawa M, Mine K, Kuwabara Y, Takeshita T, et al. Successful long-term management of adenomyosis associated with deep thrombosis by low-dose gonadotropin-releasing hormone agonist therapy. Clin Exp Obstet Gynecol. 2009. 36 (2):123-5. [QxMD MEDLINE Link].

67. Akira S, Mine K, Kuwabara Y, Takeshita T. Efficacy of long-term, low-dose gonadotropin-releasing hormone agonist therapy (draw-back therapy) for adenomyosis. Med Sci Monit. 2009 Jan. 15 (1):CR1-4. [QxMD MEDLINE Link].

68. Takebayashi T, Fujino Y, Umesaki N, Ogita S. Danazol suspension injected into the uterine cervix of patients with adenomyosis and myoma. Preliminary study. Gynecol Obstet Invest. 1995. 39 (3):207-11. [QxMD MEDLINE Link].

69. Igarashi M, Abe Y, Fukuda M, Ando A, Miyasaka M, Yoshida M, et al. Novel conservative medical therapy for uterine adenomyosis with a danazol-loaded intrauterine device. Fertil Steril. 2000 Aug. 74 (2):412-3. [QxMD MEDLINE Link].

70. Cobellis L, Razzi S, Fava A, Severi FM, Igarashi M, Petraglia F. A danazol-loaded intrauterine device decreases dysmenorrhea, pelvic pain, and dyspareunia associated with endometriosis. Fertil Steril. 2004 Jul. 82 (1):239-40. [QxMD MEDLINE Link].

71. Badawy AM, Elnashar AM, Mosbah AA. Aromatase inhibitors or gonadotropin-releasing hormone agonists for the management of uterine adenomyosis: a randomized controlled trial. Acta Obstet Gynecol Scand. 2012 Apr. 91 (4):489-95. [QxMD MEDLINE Link].

72. Kimura F, Takahashi K, Takebayashi K, Fujiwara M, Kita N, Noda Y, et al. Concomitant treatment of severe uterine adenomyosis in a premenopausal woman with an aromatase inhibitor and a gonadotropin-releasing hormone agonist. Fertil Steril. 2007 Jun. 87 (6):1468.e9-12. [QxMD MEDLINE Link].

73. Leyendecker G, Bilgicyildirim A, Inacker M, Stalf T, Huppert P, Mall G, et al. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol Obstet. 2015 Apr. 291 (4):917-32. [QxMD MEDLINE Link].

74. Benagiano G, Habiba M, Brosens I. The pathophysiology of uterine adenomyosis: an update. Fertil Steril. 2012 Sep. 98 (3):572-9. [QxMD MEDLINE Link].

75. Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd. 2013 Sep. 73 (9):924-931. [QxMD MEDLINE Link].

76. Vercellini P, Viganò P, Somigliana E, Daguati R, Abbiati A, Fedele L. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol. 2006 Aug. 20 (4):465-77. [QxMD MEDLINE Link].

77. Jeng CJ, Huang SH, Shen J, Chou CS, Tzeng CR. Laparoscopy-guided myometrial biopsy in the definite diagnosis of diffuse adenomyosis. Hum Reprod. 2007 Jul. 22 (7):2016-9. [QxMD MEDLINE Link].

Lisa Kirsten Ely, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Lisa Kirsten Ely, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Medical Association

Disclosure: Nothing to disclose.

Mireille Truong, MD Assistant Professor, Director of Minimally Invasive Gynecologic Surgery, Virginia Commonwealth University Medical Center

Mireille Truong, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Yonah Korngold

Disclosure: Nothing to disclose.

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.

• Print this section
• Print the entire contents of
• Print the entire contents of article