Adenomyosis uteri seen during laparoscopy: soft and enlarged uterus; the blue spots represent subserous endometriosis.
  • Uterine disorder characterized by endometrial glands and stroma being present within the myometrium resulting in hypertrophy of the surrounding myometrium
  • Two histopathological forms:
    • Diffuse – results in the uterus being uniformly enlarged and boggy
    • Focal (also known as an adenomyoma) – can appear similar to a fibroid but does not have a pseudocapsule
  • Pathogenesis is not well understood

Clinical Features

Differential Diagnosis

Nonpregnant Vaginal Bleeding

Systemic Causes

Reproductive Tract Causes


Sagittal MRI showing uterus with adenomyosis in the posterior wall: gross enlargement with many foci of hyperintensity.
  • Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus
  • Transvaginal US
  • MRI usually reserved in cases when providers are seeking to distinguish between adenomysosis and leiomyomas [1]
  • Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy


  • Hysterectomy is the definitive treatment
  • Alternative options include
    • Hormonal therapy such as with a levonorgestrel IUD [2] [3] [4]
  • Uterine artery embolization
  • Uterus sparing resection


  • Final disposition should be made based on hemodynamic stability of the patient
  • If hemodynamically stable without clinically significant bleeding, patient can be discharged with gynecology referral

See Also

External Links


  1. Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH. Diffuse and focal adenomyosis: MR imaging findings. Radiographics. 1999;19 Spec No:S161-S170. doi:10.1148/radiographics.19.suppl_1.g99oc03s161
  2. Fong YF, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999;60(3):173-175. doi:10.1016/s0010-7824(99)00075-x
  3. Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril. 1997;68(3):426-429. doi:10.1016/s0015-0282(97)00245-8
  4. Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception. 2009;79(3):189-193. doi:10.1016/j.contraception.2008.11.004