Diffuse Adenomyosis
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Understand diffuse involvement of the uterine muscle—diagnosis, imaging features, symptoms, and how it differs from focal disease. Review treatments, fertility considerations, and overlap with endometriosis.
Overview
Diffuse adenomyosis is widespread growth of endometrial tissue within the uterine muscle, often causing a globally enlarged, tender uterus with heavy or prolonged bleeding and severe cramps. It differs from focal adenomyosis (adenomyoma), which is localized. Diagnosis relies on pattern recognition: MRI may show a thickened, irregular junctional zone and small myometrial cysts; transvaginal ultrasound often reveals a heterogeneous, streaked myometrium, asymmetric wall thickening, and a globular uterine contour. Understanding these imaging features helps explain symptoms and guides tailored care; for test preparation and report details, see Imaging & Diagnosis (MRI, Ultrasound).
Treatment focuses on symptom control and life goals. Hormonal approaches such as a levonorgestrel IUD, continuous progestins, or GnRH antagonists can lighten bleeding and reduce pain; NSAIDs address cramping. Because disease is diffuse, complete uterus-sparing excision is difficult, though selective debulking may help in experienced hands; hysterectomy remains definitive for those finished with childbearing. Diffuse involvement can hinder implantation and increase miscarriage risk, so coordinated planning with a fertility specialist is key; see Fertility Considerations and Surgical Options. When endometriosis coexists, comprehensive mapping and combined management improve outcomes; see Endometriosis and Diagnostics & Imaging.
How is diffuse adenomyosis different from focal adenomyosis?
Diffuse adenomyosis involves the uterine muscle broadly, leading to global enlargement and heavy bleeding, whereas focal disease forms a localized adenomyoma. Imaging helps tell them apart: diffuse disease shows widespread changes across the myometrium, while focal disease appears as a discrete, often well-circumscribed area. The diffuse pattern makes fertility-sparing surgery more challenging.
How do doctors confirm diffuse adenomyosis on imaging?
MRI often shows an irregularly thickened junctional zone, low-signal bands, and small myometrial cysts scattered through the wall. Transvaginal ultrasound may reveal a heterogeneous, streaky myometrium with asymmetric thickening and fan-shaped shadowing. These findings, combined with symptoms and exam, support diagnosis; learn more in Imaging & Diagnosis (MRI, Ultrasound).
Can diffuse adenomyosis be managed without hysterectomy?
Yes. Many people improve with a levonorgestrel IUD, continuous progestins, or GnRH antagonists with add‑back therapy; NSAIDs help with cramps. Uterus-sparing surgery or uterine artery embolization may be options in select cases, especially if not seeking pregnancy, but choices and risks should be reviewed under Surgical Options.
How does diffuse adenomyosis affect fertility and miscarriage risk?
Diffuse involvement can disrupt uterine contractility and implantation, contributing to subfertility and a higher risk of early miscarriage. Pretreatment with hormonal therapy and carefully timed conception or IVF may improve outcomes in some cases. Individualized planning is essential; see Fertility Considerations for protocols and counseling.
What if I also have endometriosis?
Coexistence is common and can intensify pelvic pain and fertility challenges. A coordinated plan that maps disease across the pelvis with expert ultrasound or MRI and addresses both conditions—medical, surgical, and rehabilitative—tends to yield better results. Related resources include Endometriosis and Diagnostics & Imaging.
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