RSA Institute - English Channel
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RSA Institute - English Channel
Adenomyosis is also known as endometriosis interna. Adenomyosis is a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the myometrium. Women affected by adenomyosis may present with abnormal uterine bleeding (AUB), dysmenorrhea, dyspareunia, or infertility but one third of them are asymptomatic. For many years, adenomyosis has remained a histopathological diagnosis made after hysterectomy in perimenopausal women with heavy menstrual bleeding (HMB) or pelvic pain. Over the last decade, adenomyosis has also become a condition identified in young fertile-age women4 thanks to the recent advancements in imaging techniques, even though a shared definition and classification are still lacking . Despite the improvement of diagnostic tools, the awareness of the condition is still poor. Furthermore, in some patients, adenomyosis coexists with other gynecological conditions, such as endometriosis and uterine fibroids6 . The physio-pathological mechanisms, involving sex steroid hormone aberrations, inflammation, fibrosis, and neuroangiogenesis, are not fully understood7 . Regarding the current management of adenomyosis, there are no international guidelines to follow for surgical or medical treatment of adenomyosis8 and this will be of utmost importance in the future as the disease requires a lifelong management plan, including pain and bleeding control, fertility preservation, and pregnancy outcome.
In fact, adenomyosis pathogenesis remains elusive and not a single theory can explain all of the different phenotypes of the disease. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. Treatment requires a lifelong management plan as the disease has a negative impact on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome and has a high risk of miscarriage and obstetric complications.
According to the most common theory, adenomyosis results from the invagination of basalis endometrium into the myometrium through an altered or interrupted junctional zone, which represents a highly specialized hormone-responsive structure located in the inner third of the myometrium.
3 years ago | [YT] | 1
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