Retrospective Analysis of Changing Trends in Presentation and Management of Adenomyosis

Abstract

Background Adenomyosis is a challenging clinical condition, usually diagnosed between 35 to 50 years of age, with prevalence among hysterectomy ranged from 8.8% to 61.5%. Women with adenomyosis have a prole of symptoms which includes abnormal uterine bleeding, dysmenorrhea, dyspareunia, chronic pelvic pain and subfertility. The condition was diagnosed pathologically in hysterectomy specimens by microscopy but now preoperative diagnosis is done by magnetic resonance imaging (MRI) and transvaginal sonography (TVS) and medical or surgical treatments are proposed as per the diagnosis. The diagnosis of adenomyosis as such becomes difcult due to the coexistence with other conditions like endometrial hyperplasia and uterine leiomyomas. Methods This is a retrospective, cross-sectional study done among 100 women admitted in the Gynaecology ward in Chettinad Hospital and Research Institute, Kelambakkam during the period of August 2019 to August 2020. Women with complaints of abnormal uterine bleeding and had hysterectomy were included. The patient's data were retrieved from the subject's case sheets obtained from Medical Records Department. The histopathological examination reports were retrieved from the Department of Pathology. The data collected were listed in Microsoft Excel v365 and interpreted using statistical software SPSS v21. Results Among the subjects, 35% were found to have adenomyosis in the histopathological diagnosis. Out of those, 6% had only adenomyosis followed by 11% with leiomyoma, 13% with endometrial hyperplasia and 5% with both leiomyoma and endometrial hyperplasia. 71.4% of adenomyosis were in 41 -50 years age group and 80% were multiparous. The most common presenting symptom in adenomyosis subjects were Menorrhagia (74.3%) followed by Dysmenorrhoea and Intermenstrual Bleeding with almost 50%. Conclusion Over the few years, a dramatic change has been attained in presentation and management of adenomyosis. It has turned into a clinical diagnosis rather than a histological entity and can be appreciated through imaging techniques, even though a common denition and classication are still in paucity. This will be of maximum concern in the forthcoming years as the disease needs to have a enduring treatment and so it has to be diagnosed earlier to provide better medical or surgical therapies and to avoid hysterectomy.