Prevalence of adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding, pelvic pain or uterine prolapse - A retrospective cohort study

Abstract

Background: Adenomyosis can cause symptoms like dysmenorrhea, dyspareunia, pelvic pain and bleeding disorders and is related to subfertility and obstetrical complications. The disease is probably underestimated and underdiagnosed because of difficulties in reliable clinical examination and imaging results. The age-related prevalence of adenomyosis still remains unclear. In this retrospective analysis we describe the rate of adenomyosis in two independent cohorts of patients undergoing hysterectomy for benign diseases (2011-2013 and 2015-2018) and its correlation to presurgical symptoms respectively indications for hysterectomy.

Materials and methods: All surgeries have been performed in the same department of minimally invasive gynecological surgery by a total of two experienced surgeons following a surgical internal standard for the indication bleeding disorder, dysmenorrhea. We analyzed the overall rate of patients with adenomyosis in both cohorts and related the histological presence of adenomyosis to presurgical symptoms. We also analyzed a subgroup of postmenopausal patients with uterine prolapse.

Results: In 307 patients we detected 42.0% of cases with histologically proven adenomyosis. In the group of patients with bleeding disorders and dysmenorrhea as indication for surgery we found the highest rate of adenomyosis (59.3%, cohort 1). 81,1% patients with adenomyosis (cohort 1) reported symptoms. In the subgroup of 42 postmenopausal patients, we found 23.8% of cases with adenomyosis.

Conclusion: Our data shows that a positive anamnesis regarding the symptoms bleeding disorders and dysmenorrhea is suspicious for adenomyosis. In hysterectomy specimen adenomyosis can be found in more than 40%. The role of adenomyosis-related symptoms requires further investigation, especially in adolescent and postmenopausal patients.

Keywords: Adenomyosis; Bleeding disorders; Dysmenorrhea; Endometriosis; Enzian classification; Laparoscopic hysterectomy; Pelvic pain.

Fig. 1

Laparoscopic appearance of adenomyotic uterus with subserous cystic adenomyosis and hypervascularization.

Fig. 2

Laparoscopic blue sign in adenomyosis during test of fallopian tube permeability with blue dye. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Adenomyotic uterine tissue during laparoscopic subtotal hysterectomy with laparoscopic in-bag morcellation.

Fig. 4

Transvaginal ultrasound in adenomyotic uterus with subendometrial cysts, hyperechoic spots, irregular myometrium.

Fig. 5

Subendometrial microcysts in uterus with adenomyosis.

Fig. 6

Myometrial cystic lesion in uterus with adenomyosis.