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Adenomyosis

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This is a disease of a part of the endometrium proliferating abnormally in the myometrium, usually found in women over 40 of age. Excessive amounts of menstruation and extension of menstruation period, menstrual cramps are the most common symptoms. Dyspareunia and pelycalgia also appear commonly. Menstrual cramps start a week before menstruation and may continue until menstruation stops. As the endometrium tissue proliferates in the myometrium abnormally, the whole uterus enlarges and becomes heavy. Generally, the uterus wall gets about 2-2.5cm thicker, but 20-25% shows normal uterus size. The endometrium tissue in the myometrium often is influenced by hormones and cause bleeding during the menstruation period. In this case, the lesion color is reddish brown. About 15% of the patients are accompanied with endometriosis and over 50% has uterine myoma.
Based on ultrasound image, the anterior, posterior wall of the uterus get thicker and shows an asymmetric feature. The boundary within the myometrium is unclear and appears as a heterogeneous shadow. Definite diagnosis can be made through biopsy.

Symptoms of Adenomyosis are similar with uterine fibroid. Symptoms are functional disorder types of metrorrhagia, secondary menstrual pain and it can promote uterine with pain, dyspareunia and chronic pelvic pain etc. and about 35% of it creates no symptoms. About 2/3 of functional disorder type metrorrhagia exhibits menorrhagia and the rate of polymenorrhea is quite low.
Reason of excessive bleeding during menstruation is increase of volumes in uterine cavity and it can be connected with role of prostaglandin and hyperestrogenemia, and dysmenorrhea seems to be connected with prostaglandin. Dyspareunia’s reason is unclear unless it accompany endometrial hyperplasia and in histological way, the symptoms can be even slight with acute adenomyosis patients and to be opposite, sometimes it exists in affected area or in many times patient with non-functional adenomyosis complain severe pain. It is rare that adenomyosis exist by itself and about 80% of it accompanying myoma, endometrial hyperplasia, endometriosis and endometrial cancer etc. Fact of all disease above is connected to long term estrogen expose suggest that adenomyosis is connected with hyperestrogenemia. Disease that most accompany with adenomyosis is myoma of the uterus and it is about 57%. Even with many similar point with adenomyosis, endometriosis is accompanies only about 27%.
In case of myoma, the boundary of normal myometrium is clear and divided, so it is possible to extract only the myoma. However, in cases of adenomyosis, the endometrium tissue is distributed evenly within the myometrium without any boundaries. It is impossible to selectively remove abnormally proliferated endometrium tissue. As for complete recovery, hysterectomy is considered as the only way. Recently, there is a movement to improve the quality of life of women by preserving the uterus than unconditionally removing it and as a result, Radiofrequency ablation (RF Myolysis) is being highlighted for uterus preservation treatment for adenomyosis. At present, many university and specialized hospitals enforce RF Myolysis to women who want to preserve the uterus. As the abnormally proliferated endometrium tissue is protein degenerated by radiofrequency heat, it goes through necrosis, absorption, and finally the enlarged uterus slowly reduces. Improvement effects of symptoms such as menstrual cramps are quite satisfying. Therefore, it is recommended to enforce RF Myolysis before reckless hysterectomy.