Adenomyosis is a benign gynecological condition characterized by the presence of endometrial-like glands and stroma within the myometrium (the muscular layer of the uterus). This invasion causes hypertrophy and hyperplasia of the surrounding smooth muscle, often resulting in a globally enlarged, "boggy" uterus. It is frequently associated with pelvic pain, abnormal uterine bleeding, and infertility.

The exact etiology remains idiopathic, though theories suggest the breakdown of the natural barrier between the endometrium and myometrium. Factors include postpartum uterine trauma, mechanical damage from surgeries (C-sections), or the metaplasia of pluripotent stem cells within the myometrium. Hormonal imbalances, specifically high estrogen levels, are known to fuel the proliferation of ectopic endometrial tissue.

The primary mechanism involves the invagination of the stratum basalis of the endometrium into the myometrium. This creates "adenomyotic nests" that maintain cyclic responsiveness to hormones. Chronic inflammation ensues, causing focal or diffuse enlargement of the uterus. The loss of the normal junctional zone architecture leads to hyper-peristalsis of the uterus, causing painful uterine contractions.

Adenomyosis affects approximately 10–20% of women, though prevalence estimates vary significantly based on diagnostic criteria (imaging vs. histology). It is most commonly diagnosed in multiparous women between the ages of 35 and
50.

• Prior uterine surgeries (C-section, myomectomy)
• Multiparity
• Early menarche
• Chronic hyperestrogenism
• Tamoxifen use

A. Early Symptoms

• Mildly increased menstrual cramping (dysmenorrhea)


• Slightly heavier periods (menorrhagia) B. Common Symptoms


• Severe, debilitating dysmenorrhea


• Heavy or prolonged menstrual bleeding


• Chronic pelvic pain


• Dyspareunia (painful intercourse) C. Advanced Symptoms


• Globally enlarged uterus causing bladder/bowel pressure


• Symptoms of iron-deficiency anemia (fatigue, dizziness)


• Infertility or recurrent pregnancy loss D. Emergency Symptoms


• Profuse vaginal hemorrhage requiring urgent intervention


• Acute, sharp pelvic pain suggestive of torsion or degeneration

Bimanual examination typically reveals a symmetrically enlarged, firm, yet tender uterus. It may feel "boggy" or mobile, depending on the severity of the adenomyotic foci.

A. Clinical Assessment: History of dysmenorrhea and menorrhagia.
B. Laboratory Testing: CBC to assess for anemia.
C. Imaging Studies: Transvaginal ultrasound (TVUS) and MRI.
D. Functional Tests: Not applicable.
E. Biopsy Findings: Histopathology (post-hysterectomy gold standard).
F. Genetic Testing: Not indicated.
G. Differential Diagnosis: Uterine fibroids, endometriosis, endometrial cancer.

Complete Blood Count (CBC)
Type: Blood Test
Purpose: Evaluate anemia resulting from menorrhagia.
Expected Findings: Low hemoglobin/hematocrit.
Interpretation: Indicates chronic blood loss requiring iron supplementation.