Adenomyosis: Symptoms, histology, and pregnancy terminations

Objective: To correlate symptoms of uterine adenomyosis with histopathologi c features. Methods: One hundred eleven specimens of uteri and cervices that weighed un der 280 g were reevaluated. When adenomyosis was identified, assessment inc luded depth of adenomyotic foci, graded as deep (above 80%), intermediate ( 40-80%), and superficial (under 40%), and number of adenomyotic foci. Clini cal data were collected from patient records. Results: Specimens were categorized in four groups, 17 with adenomyosis alo ne, 19 with adenomyosis with leiomyomas, 39 with leiomyomas alone, and 36 w ith neither. Among women with adenomyosis alone, 58.8% had pregnancy termin ations and 47.4% of women with adenomyosis and leiomyomas had terminations, compared with 20.5% of women with leiomyomas alone (P <.01) and 22.2% in t hose with neither (P <.01). The number of foci correlated significantly wit h depth within the myometrium in specimens With adenomyosis alone (r =.46, P =.05) or combined with leiomyomas (r=.66, P <.001). The median number of foci associated with dysmenorrhea was 10 compared with 4.5 without it (P <. 003); in menorrhagia the respective median numbers were 7 and 7 (P =.25). M enorrhagia and dysmenorrhea presented in 36.8% and 77.8% of deep, compared with 13.3% (P <.001) and 12.5% (P <.001) of intermediate depths, respective ly. Superficial depth was not associated with menorrhagia or dysmenorrhea. Conclusion: Pregnancy termination might affect the pathogenesis of adenomyo sis. The number of foci and their myometrial depths correlated to each othe r and to dysmenorrhea, but only myometrial depth correlated to menorrhagia. (Obstet Gynecol 2000;95:658-91. (C) 2000 by The American College of Obstet ricians and Gynecologists.).