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Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis.

Abstract：

:Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound.

journal_name

Fertil Steril

journal_title

Fertility and sterility

authors

Gordts S,Grimbizis G,Campo R

doi

10.1016/j.fertnstert.2018.01.006

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

380-388.e1

issue

3

eissn

0015-0282

issn

1556-5653

pii

S0015-0282(18)30006-2

journal_volume

109

pub_type

杂志文章,评审

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