Focal Adenomyosis
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Explore localized adenomyosis (adenomyoma): causes of pain and bleeding, how ultrasound/MRI spot it, and when medicines or fertility‑sparing surgery may help—plus overlaps with endometriosis and what to expect in care.
Overview
Focal adenomyosis (adenomyoma) occurs when endometrial glands and stroma grow within a contained area of the uterine muscle, forming a localized, often tender nodule. Unlike diffuse adenomyosis that involves the uterine wall more broadly, a focal lesion can cause one‑sided or pinpoint cramping, heavy bleeding, or pain with sex. On imaging it may resemble a fibroid, but it lacks a crisp capsule and can show small cystic spaces. Endometriosis may coexist, which can intensify pain and period symptoms.
Diagnosis typically starts with high‑quality transvaginal ultrasound and can be refined with MRI to confirm location, size, and distance from the uterine cavity—details that guide treatment and fertility planning. Many people improve with hormonal options such as progestin IUDs or oral therapies; when symptoms persist or fertility is affected, uterus‑sparing excision (adenomyomectomy) may help selected patients. Learn how focal disease is identified and managed, how it differs from conditions like Fibroids, and when to consider advanced care. For deeper imaging detail see Imaging & Diagnosis (MRI, Ultrasound), surgical decision‑making in Surgical Options, and family‑building guidance in Fertility Considerations.
How is focal adenomyosis different from fibroids and diffuse adenomyosis?
A focal adenomyoma is a benign, ill‑defined nodule within the uterine muscle that often contains tiny cystic spaces and blends into surrounding tissue. Fibroids are smooth‑muscle tumors with a firm capsule and sharp borders, which makes them look more discrete on imaging. Diffuse adenomyosis affects the uterine wall more broadly, while focal disease is localized and may produce pinpoint tenderness or asymmetric enlargement.
What symptoms suggest a focal adenomyoma?
Common signs include localized or one‑sided period cramps, heavy or prolonged bleeding, and deep pain with sex. Some people notice a tender spot on the uterus during exam and flares that peak just before and during menses. Symptoms alone are not diagnostic, so imaging is needed to confirm the cause and rule out look‑alikes such as Fibroids.
Which test is best to confirm focal adenomyosis—ultrasound or MRI?
Skilled transvaginal ultrasound is usually the first step and can identify features like asymmetry, fan‑shaped shadowing, and small myometrial cysts. MRI adds clarity when ultrasound is inconclusive, helps distinguish adenomyoma from fibroid, and maps the lesion’s relation to the cavity to guide treatment. Choice depends on local expertise and whether surgical planning is being considered; see Imaging & Diagnosis (MRI, Ultrasound).
Can focal adenomyosis affect fertility or miscarriage risk?
Lesions that distort or lie close to the uterine cavity can hinder implantation and are linked with higher miscarriage risk, while small peripheral nodules may have less impact. Options include medical suppression before trying to conceive or IVF, and in select cases, fertility‑sparing excision to restore the uterine contour. For individualized planning, see Fertility Considerations.
When is surgery recommended, and what does it mean for future pregnancy?
Adenomyomectomy may be considered when pain or bleeding persist despite medication, when the nodule enlarges, or when fertility appears compromised by the lesion’s size or location. Risks include bleeding, scar formation, and potential uterine wall weakness; many clinicians advise a cesarean birth in future pregnancies after deep myometrial repair and a healing interval before conception. Detailed pros and cons are covered in Surgical Options.
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