Adenomyosis: A reappraisal of symptomatology

Abstract

Adenomyosis is infrequently diagnosed and its symptomatology is not clearly understood by many physicians. This is a curious state of affairs because this disorder is certainly not new. Rokitansky1 first described the condition in 1860. Von Recklinghausen's2 well-publicized article on the clinicopathological features was published in 1896. Cullen's3 unusually complete and now famous 1908 monograph, as well as other more recent studies, 4, 5, 6 has also described the disease exceedingly well. Confusion has developed because of the unfortunate and illogical inclusion of adenomyosis with pelvic endometriosis, which it only occasionally accompanies.7 The clinical findings are often altered by the frequent association of other pelvic abnormalities which are also capable of causing symptoms similar to those of adenomyosis.8For half a century, the manifestations of adenomyosis have been stated to be: progressively severe menstrual bleeding, increasingly painful dysmenorrhea, and a gradually enlarging uterus.3 This concept may be true, but we know of no adequate study which relates adenomyosis to the patient's complaints—after eliminating other associated disorders. Bayly and Yates9 indicated that patients with adenomyosis often bleed from accompanying abnormalities, but only this phase of the problem was considered. It appears that the symptomatology has been largely based upon clinical assumptions and generalizations. Be this as it may, adenomyosis deserves far more consideration than it has received, not only because of its frequency, but also because of the degree of disability which it causes.The purpose of this investigation is: (1) to ascertain the rate of occurrence, extent, and accuracy of diagnosis of adenomyosis in a private general hospital; (2) to demonstrate how adenomyosis and concomitant significant abnormalities effect the patient; and (3) to show adenomyosis as a clinical problem exclusive of coexisting disorders capable of producing similar symptoms. Such a reappraisal should aid in earlier and more accurate diagnosis, as well as better treatment of abnormal uterine bleeding and pelvic pain.