Adenomyosis: symptoms, histology, and pregnancy terminations.

OBJECTIVE: To correlate symptoms of uterine adenomyosis with histopathologic features.

METHODS: One hundred eleven specimens of uteri and cervices that weighed under 280 g were reevaluated. When adenomyosis was identified, assessment included depth of adenomyotic foci, graded as deep (above 80%), intermediate (40-80%), and superficial (under 40%), and number of adenomyotic foci. Clinical data were collected from patient records.

RESULTS: Specimens were categorized in four groups, 17 with adenomyosis alone, 19 with adenomyosis with leiomyomas, 39 with leiomyomas alone, and 36 with neither. Among women with adenomyosis alone, 58.8% had pregnancy terminations 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 those with neither (P <.01). The number of foci correlated significantly with 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). Menorrhagia 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, respectively. Superficial depth was not associated with menorrhagia or dysmenorrhea.

CONCLUSION: Pregnancy termination might affect the pathogenesis of adenomyosis. The number of foci and their myometrial depths correlated to each other and to dysmenorrhea, but only myometrial depth correlated to menorrhagia.