Adenomyosis - MITR

adenomyosis

Adenomyosis

Adenomyosis is similar to fibroid in its presentation except that adenomyosis does not have
well defined margins for separating it from the normal uterine tissue.Generalised
adenomyosis is the cause of extreme pain during menstrual cycle with menstrual
irregularity.Ultrasound presentation of adenomyosis is cystic endometrial hyperplasia seen in
the lining of the uterus.
Management
Medical management comprises of use of mefenamic acid preparation ,tranexamic acid
,progestins oral,injectable or as intrauterine device.

Surgery for Cystic endometrial hyperplasia
Hysteroscopic resection of endometrium also known as TCRE trans cervical resection of
endometrium is performed through normal birth passage /vagina using resectoscope assembly
with thermal energy to ablate the endometriotic tissue .There is very minimal blood loss and
post procedure some amount of erratic blood loss is expected for few days.It is a daycare
procedure and requires anaesthesia.

Endometriosis

Definition: Endometriosis is a gynecological condition in which normal uterine cavity lining called endometrium is implanted in and around the female reproductive tract.

Epidemiology: Endometriosis is a hormone specific disease and is commonly seen in the reproductive age group. Incidence is unknown because disease diagnosis is based on biopsy or laparoscopic visualization of endometrial implants. Reports show the rate as high as 20%-50% in female partner of infertile couples. The incidence increases with age from 12% in girls aged 11-13 yrs to 45% in females aged 20-21 yrs. There are increasing reports of Endometriosis in females after menarche. In menopause the disease process halts.

Etiology and Pathophysiology is poorly understood. Retrograde menstruation, genetics, immunological dysfunction are few leading theories which attempt to explain the cause of endometriosis although none of these theories have been proven.

The common sites in which endometriosis is seen are –

Ovaries
Posterior cul-de-sac
Uterosacral ligament
Broad ligament
Rectosigmoid colon
Bladder
Ureter

Symptoms and Signs:

Clinical presentation depends on the site of the disease. Endometriosis is commonly seen in the ovary as chocolate cyst or endometriotic cyst which gives rise to severe abdominal pain. Adhesion formation around the reproductive organs distorts the anatomy and, all of these collectively are responsible for infertility in women. 30%-40% of women will be subfertile. Severe dysmenorrhoea, pelvic pain are the other common presenting complaints. Symptoms of endometriosis do not co-relate well with disease severity.

Investigations:

Pelvic sonography, computed tomography (CT) scan and MRI (magnetic resonance imaging) are useful imaging modalities in visualization of endometriotic cyst.

Transvaginal sonography is useful in identifying endometriotic cyst.
MRI has increased sensitivity over transvaginal sonography.
CT Scan is a useful tool in diagnosing complicated cases like bowel obstruction, kidney obstruction due to endometriosis
Intravenous pyelography and colonic studies are to be performed in case of extra-uterine endometriotic involvement.
CA-125 cancer antigen test has poor sensitivity index in detecting endometriosis.
Laparascopy is the only confirmative but invasive diagnostic tool in endometriosis.


TREATMENT

Medical therapy

1. Progesterone preparation gives promising results in treating endometriosis.
2 .Pain relief due to the disease is best achieved with the use of anti inflammatory drugs.

There can be good disease control and pain relief with medical line of management.

Surgical management

1. Conservative surgery is performed in cases of infertility, adolescent age group and where reproductive function is desired.
2 .Radical surgery is performed in extensive and deep endometriosis.