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Adenomyosis is a myometrial lesion characterized by the presence of ectopic endometrium with hyperplasia of the surrounding myometrium and leiomyomas are benign myometrial neoplasms. Commonly reported symptoms of adenomyosis are menorrhagia, chronic pelvic pain, and dysmenorrhea; whereas, menorrhagia, pain, pelvic pressure, and bowel and urinary tract complaints are reported in leiomyomas. However, adenomyosis and leiomyomas commonly coexist and therefore attributing symptoms to either of the condition is problematic. Therefore, author carried out a retrospective questionnaire-based study to compare the disease burden of women undergoing hysterectomy with a pathologic ﬁnding of adenomyosis and leiomyomas and women with leiomyomas alone.
Total 1,112 white women (since January 1, 2007, to December 31, 2010) with a hysterectomy and a histologic diagnosis of both adenomyosis and uterine leiomyomas and women with leiomyomas alone were included in this study. Out of which only 561 women responded to the mailing and 560 women returned questionnaires. Women were analyzed by using symptom questionnaire, which was based on the Uterine Fibroid Symptom (UFS) Quality of Life (QOL) Questionnaire with the addition of ﬁve symptoms, like pelvic pain during the menstrual period, pelvic pain not associated with the menstrual period, intermenstrual bleeding, spotting, and painful sexual intercourse. The mean period between surgery and mailing of the symptom questionnaires was 2.1±1.1 years. A retrospective review of medical records was performed and statistical tests were used for the analysis of the data where P<.05 was considered to be statistically signiﬁcant.
• Out of 560 responded women, 159 women (28.4%) were with adenomyosis and leiomyomas, and 401 women (71.6%) were with leiomyomas alone.
• Women with adenomyosis and leiomyomas were significantly older (47.4 ± 4.1 vs. 45.9 ± 4.2 years; P≤0.001), had signiﬁcantly more pregnancies (2.3 ± 1.5 vs. 1.7 ± 1.3; P<.001), and were signiﬁcantly more likely to have a history of miscarriage (P=0.040) than the women with leiomyomas alone.
• Women with adenomyosis and leiomyomas were more likely to have at least one (P=0.007) or more than one (P=0.007) vaginal (p=0.005) delivery compared with women with leiomyomas.
• Women with a concomitant diagnosis of adenomyosis and leiomyomas had signiﬁcantly higher scores for disease burden during the menstrual period (heavy bleeding episodes [P=0.005] and passing blood clots [P=0.005]) , distress regarding ﬂuctuations in the length of the menstrual cycle (P=0.015), pelvic pain occurring during the menstrual period (P=0.008), pelvic pain not associated with the menstrual cycle (P=0.049), and feeling fatigued (P=0.001) before surgery than in women with leiomyomas alone.
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• Women with leiomyomas who were older (P=0.002) and with a history of pregnancy (P<.001) were more likely to have a concomitant diagnosis of adenomyosis and the risk of a concurrent diagnosis of adenomyosis in women with leiomyomas was increased by pelvic pain during menstrual period (p=0.012).
• A higher uterine weight was protective for a concomitant diagnosis of adenomyosis (P=0.002).
• With an increase in uterine weight, decreases in the risk of leiomyomas have a concomitant diagnosis of adenomyosis (an increase by 100 g gave an OR of 0.7,6 an increase by 150 g gave an OR of 0.66, and an increase by 200 g gave an OR of 0.57) was reported.
• At the time of hysterectomy, a number of symptoms distinguish women with adenomyosis and leiomyomas from women with only leiomyomas.
• Women with adenomyosis and leiomyomas reported signiﬁcantly higher scores for disease burden during the menstrual period, ﬂuctuations in the length of the monthlycycle, pelvic pain, and intermenstrual bleeding.
Adenomyosis contributes to symptomatology in women with concomitant adenomyosis and leiomyomas.
Brucker SY, Huebner M, Wallwiener M et al. Clinical characteristics indicating adenomyosis coexisting with leiomyomas: a retrospective, questionnaire-based study. Fertil Steril. 2013 Nov 1. pii: S0015-0282(13)03112-9. doi: 10.1016/j.fertnstert.2013.09.038. [Epub ahead of print]