La adenomyosis It is a chronic, estrogen-dependent disease in which endometrial tissue appears and grows outside the uterine cavity, producing an inflammatory reaction.
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Relevant aspects of adenomyosis
- It is a benign and frequent disease but very little diagnosed or suspected.
- The number of posts with Main MeSH "ADENOMYOSIS" is 10% that of the endometriosis.
- Important clinical and health problem with implication in health costs, quality of life.
- Classically post-hysterectomy diagnosis.
- Preoperative diagnosis now possible.
- There are ectopic endometrial glands and stroma in the thickness of the myometrium.
- Produces a local inflammatory response.
- There is a variable degree of hyperplasia in the adjacent myometrium.
A very important aspect that must be known is the mechanical activity of the non-pregnant uterus that in the first 10 years of a woman's reproductive life there are 10 × 10 (6) peristaltic activities (35 mm Hg) 130 × 10 (3) menstrual endometrial contractions (200-300 mm Hg).
La pathogenesis of adenomyosis It is generated by a disruption of the interface between the basal endometrium and the myometrium, producing a myometrial invasion by endometrial glands and stroma. Disruption of the endometrial-myometrial interface can be favored by a cesarean section, a myomectomy, curettage and other surgical interventions.
The clinical forms of adenomyosis can be:
- Diffuse adenomyosis
- Endometrial glands and stroma present throughout the endometrium
- Focal adenomyosis
- Endometrial glands and stroma in restricted areas of the myometrium
- Cystic adenomyoma
- Other forms
Symptoms of adenomyosis
- In menstruation:
- Abnormal uterine bleeding
- Rules with heavy bleeding
- Rules of excessive duration
- Clot emission during menstruation
- Spotting (abnormal bleeding) between periods
- Severe dysmenorrhea
- Pelvic pain
- Lumbar pain
- Enlarged uterus
- Other symptoms
- Chronic pelvic pain
- Abnormal uterine-tubal transport
- Intrauterine abnormalities
- Alteration of uterine peristalsis and sperm transport • Alteration of endometrial architecture and its function
- Altered endometrial function
- Aberrant endometrial metabolism
- Alteration of the endometrial oxidative environment
- Alteration of implantation
Dr Francisco Carmona
Medical Director of the Women's CD gynecological clinic in Barcelona
Head of Gynecology at Hospital Clinic de Barcelona