Diagnostics

• Patient history

• Physical examination

  • Rectovaginal tenderness

  • Adnexal masses

  • Lateral displacement of the cervix (due to uterosacral scarring)

• Transvaginal ultrasound (best initial test)

  • The uterus is generally not enlarged.

  • Evidence of ovarian cysts (chocolate cysts)

  • Nodules in bladder or rectovaginal septum

• Laparoscopy (confirmatory test): may show endometriotic implants and adhesions

Normally the severity of the findings does not correlate with the severity of symptoms.

• Endometrium: endometrial implants that present as yellow-brown (sometimes reddish-blue) blebs, islands, or pinpoint spots

• Ovaries

  • Gunshot lesions or powder-burn lesions

    • Black, yellow-brown, or bluish nodules or cystic structures

    • Seen on the serosal surfaces of the ovaries and peritoneum

  • Ovarian endometriomas or chocolate cysts: cyst-like structures that contain blood, fluid, and menstrual debris

• Fallopian tubes: salpingitis isthmica nodosa

  • Nodular tube changes, resulting in:

    • ↑ Risk of sterility and ectopic pregnancy

    • ↓ Transmittance

• Normal endometrial glands

• Normal endometrial stroma

• Preponderance of hemosiderin laden macrophages due to cyclic hemorrhages into endometriomas

Adenomyosis

• Definition: benign disease characterized by the occurrence of endometrial tissue within the myometrium due to hyperplasia of the endometrial basal layer

• Epidemiology: peak incidence at 35–50 years

• Etiology: The exact etiology is unknown, though some risk factors have been identified:

  • Endometriosis

  • Uterine fibroids

  • Parity

• Clinical features

  • May be asymptomatic

  • Dysmenorrhea

  • Abnormal uterine bleeding

  • Chronic pelvic pain, aggravated during menses

  • Globular, uniformly enlarged uterus that is soft but tender on palpation

• Diagnostics

  • Diagnosis is clinical and may be supported by transvaginal ultrasound and MRI findings

    • Asymmetric myometrial wall thickening [5][6]

    • Myometrial cysts

  • Histology serves to confirm the diagnosis.

• Treatment

  • Conservative

    • Combined oral contraceptives ,

    • Progestin-only contraception (e.g., IUD, continuous-use contraceptive pill)

    • NSAIDs for pain relief

    • GnRH agonists

  • Surgical

    • Hysterectomy is the definitive treatment.

    • Excision of single, organized adenomyomas.