ADENOMYOSIS
What is adenomyosis?
Adenomyosis is a common, benign gynaecological condition in which tissue similar to the lining of the uterus is found within the muscular wall of the uterus.
It can affect part of the uterus (focal adenomyosis) or be more widespread throughout the uterine muscle (diffuse adenomyosis). Adenomyosis can occur on its own or together with other conditions, particularly endometriosis and fibroids.
Some women with adenomyosis have no symptoms. For others, it can significantly affect quality of life.
Symptoms may include:
- painful periods
- heavy or prolonged menstrual bleeding
- pelvic pain or aching
- back pain
- pelvic pressure or bloating
- pain during intercourse
- difficulty becoming pregnant
- worsening period symptoms over time
The severity of symptoms does not always correspond to the extent of adenomyosis seen on imaging.
How is adenomyosis diagnosed?
Ultrasound is the first-line investigation
Adenomyosis can now often be diagnosed without surgery.
The Australian Living Evidence Guideline recommends ultrasound as the first-line investigation when adenomyosis is suspected.
A detailed transvaginal pelvic ultrasound allows the uterine muscle to be carefully assessed for recognised features of adenomyosis. These may include changes in the shape and thickness of the uterine wall, small cysts within the muscle, altered tissue appearance and changes at the junction between the endometrium and the uterine muscle.
Modern specialist ultrasound may incorporate 2D and 3D imaging and Doppler assessment to provide a detailed evaluation of the uterus.
Why does specialist ultrasound matter?
Adenomyosis can be subtle, particularly when disease is focal or early. It's diagnosis depends not only on the ultrasound equipment being used but also on recognition and interpretation of specific ultrasound features of the uterine muscle. A detailed gynaecological ultrasound can help determine:
- whether features of adenomyosis are present
- whether the changes are focal or diffuse
- which areas of the uterus are affected
- whether fibroids or other uterine abnormalities are also present
- whether there is associated endometriosis
- how the findings may influence treatment or fertility planning
MRI can sometimes provide additional information and may be recommended when ultrasound findings are inconclusive or when further assessment is clinically indicated.