Uterine Surgery and Risk of Adenomyosis: A Retrospective Study

Abstract

<h3>Study Objective</h3> To determine an association between adenomyosis and history of uterine surgery, including cesarean section, dilation & curettage (D&C), and myomectomy. Also, if repeat uterine surgery increases the risk of adenomyosis development. <h3>Design</h3> Retrospective case control study. <h3>Setting</h3> Large academic center, Parkland Hospital in Dallas, TX. <h3>Patients or Participants</h3> Data was collected from electronic medical records of women who underwent hysterectomy for benign indications at Parkland Hospital between January 2014-December 2018. A total of 2911 women were included, 1184 with adenomyosis and 1727 without adenomyosis. <h3>Interventions</h3> Variables included gravidity/parity, number of vaginal deliveries, number of cesarean sections, number of D&C procedures, and number of myomectomies. Pathology of uterine specimens were noted for presence of adenomyosis, leiomyomata, and endometriosis. Non-parametric rank sum test compared medians of continuous variables, Chi-square or Fisher exact tests compared categorical variables. Logistic regression was used to generate odds ratios for adenomyosis and clinical factors. <h3>Measurements and Main Results</h3> History of any uterine surgery was associated with an increased risk of adenomyosis (OR 1.28, 95% CI 1.11-1.49). Patients with a history of D&C were significantly more likely to have adenomyosis on pathology (OR 1.57, 95% CI 1.30-1.90). Repeat D&C was also associated with increased risk of adenomyosis (OR 1.31, 95% CI 1.01-1.72). The association between history of prior cesarean section and adenomyosis was not statistically significant (OR 1.12, 95% CI 1.00-1.37). A history of myomectomy was not significantly associated with adenomyosis (OR 0.95, 95% CI 0.59-1.54). <h3>Conclusion</h3> Of the risk factors explored, history of any uterine surgery, D&C and repeat D&C were associated with an increased risk of adenomyosis. However, there was not a significant association between history of cesarean section or increasing numbers of repeat cesarean delivery with the development of adenomyosis. This is the largest known retrospective study thus far investigating this association and we concluded that cesarean sections do not individually increase the risk of adenomyosis.