Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN)

Abstract

Objective-Our study evaluates the symptoms commonly attributed to adenomyosis in women undergoing the menopausal transition. We hypothesized that adenomyosis is more commonly seen in women with fibroids, pelvic pain, abnormal uterine bleeding, and in the presence of endometriosis. Design-Retrospective cohortSetting-multi-site community based study Patients-SWAN study enrollees who had hysterectomies Interventions-None Main Outcome Measurements-Relationship of Adenomyosis to other entitiesResults-Adenomyosis was found in 48% of 137 patients. Frequencies of presenting symptoms were similar in those with and without evidence of adenomyosis. The same prevalence of fibroids, 37 % versus 43% (p=0.39), endometriosis, 3% versus 5% (p=0.41), abnormal bleeding, 27% versus 33% (p=0.72), or chronic pelvic pain in the presence of fibroids 12% versus 17%, (p=0.58), was seen in the presence or absence of adenomyosis.Conclusions-Adenomyosis is a common diagnosis seen in hysterectomized specimens from women undergoing the perimenopausal transition. Adenomyosis is equally common in women who also have fibroids, endometriosis, pelvic pain, or abnormal uterine bleeding, and those women that do not. Therefore, adenomyosis is an incidental finding, not the source of the symptomatology. It appears not to be a "disease" per se, but a normal variant.

Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients

“…We cannot confirm previous findings that describe adenomyosis as a variant and not a distinct disease [11]. In our study, women with adenomyosis alone were younger, and had lower uterine weights and more disease-specific symptoms.…”

“…Adenomyosis and leiomyomas commonly coexist, and concomitant adenomyosis in hysterectomy specimens of women with leiomyomas is found in 15-57% of cases [7][8][9][10][11][12]. Distinguishing between the symptoms of both can, therefore, be problematic [13].…”

“…The preoperative diagnosis of adenomyosis remains poor, however, and it has been suggested that adenomyosis is solely an incidental finding at hysterectomy for benign disease and not the source of the typical symptoms [11]. To further characterize adenomyosis as a disease entity, we compared women undergoing hysterectomy with a pathologic finding of only adenomyosis to women with adenomyosis and leiomyomas and to women with leiomyomas alone using a multinomial logistic regression model.…”

The pathophysiology of uterine adenomyosis: an update

“…This is not an easy issue to address without reference to symptoms or other functional parameters, and the clinical correlates of adenomyosis remain a matter for debate (36). Indeed, the difficulty in identifying unique clinical features linked to adenomyosis led to the proposal that adenomyosis be considered as a physiologic variant (37); unfortunately, this small study did not involve a control group of asymptomatic women or unified diagnostic criteria. In addition, failure to demonstrate statistical differences does not prove that differences do not exist.…”

Successful metroplastic operation after medical therapy with selective modulators of progesteron receptors in a patient with prolifera­ting myoma and adenomyosis (case report)

“…Точно так же, к характерным клиническим проявлениям аде-номиоза относят меноррагии и альгоменорею [6,8,12].…”