The prevelance of adenomyosis at hysterectomy and associated factors

Abstract

Objective: Adenomyosis is a entity characterized by the presence of endometrial glands and stroma embedded within the myometrium without apparent contact with the endo-myometrial junction. As the diagnosis of adenomyosis is based on histological examination, the condition is best described in women at the time of hysterectomy.

Material and Methods: We evaluated results of 109 hysterectomized patients retrospectively. Age, parity, menopausal status and indication of hysterectomy were compared between adenomyosis positive and negative patients according to histological findings. P value under 0.05 was considered statistically significant.

Results: The mean of age patients with adenomyosis were 55. Parity and abnormal uterine bleeding were associated factors with adenomyosis (p<0.05). 

Concluison: Our study demonstrated that the prevalence of adenomyosis at hysterectomy was 29.4%. Adenomyosis is more frequent among women reporting abnormal uterine bleeding and with high parity.

Keywords

• adenomyosis
• hysterectomy
• prevelance

Histerektomi olgularında adenomyosis prevelansı ve ilişkili faktörler

Öz

Giriş: Adenomyosis, endometrial gland ve stromanın endometriumla ilişkisiz bir şekilde myometrium içine gömülmesidir. Tanısı histolojik incelemeye dayandığı için, bu durum en iyi histerektomi materyallerinin incelenmesi ile belirlenmektedir. 

Gereç ve Yöntemler: Bu çalışmada histerektomi olmuş 109 hastanın sonuçları retrospektif olarak incelendi. Yaş, parite, menapozal durum ve histerektomi endikasyonları adenomyosis olan ve olmayan grup arasında karşılaştırıldı. P değerinin 0.05 altında olması istatistiksel olarak anlamlı kabul edildi. 

Bulgular: Adenomyosis olan olguların ortalama yaşı 55 idi. Parite ve anormal uterin kanama adenomyosis olan olgularda daha yüksek idi (p<0.05).

Sonuç: Bu çalışmada histerektomi materyallerindeki adenomyosis oranı % 29.4 olarak görüldü. Anormal uterin kanaması olan ve parite sayısı fazla olan olgularda adenomyosis oranı daha sık görülmüştür.

Anahtar Kelimeler

• adenomyosis
• histerektomi
• prevelansı

Kaynakça

1. Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update .1998;4(4):312–22.
2. Azziz R. Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 1989; 16(1):221–35.
3. Hunter WC, Smith LL, Reiner WC. Uterine adenomyosis; incidence, symptoms, and pathology in 1,856 hysterectomies. Am J Obstet Gynecol 1947;53(4):663-8.
4. Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women’s Health Across the Nation (SWAN). Fertil Steril 2009;91:201–6.
5. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician 2006; 74,594–600.
6. Tahlan A, Nanda A, Mohan H. Uterine adenomyoma: a clinicopathologic review of 26 cases and a review of the literature. Int. J.Gynecol. Pathol. 2006;25, 361–365.
7. Saremi A, Bahrami H, Salehian P, Hakak N, Pooladi A.Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed Online 2014;28(6):753-60.
8. Taran FA, Wallwiener M, Kabashi D, Rothmund R, Rall K, Kraemer B, et al. Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet 2012;285(6):1571-6

9. Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 2001;16(11):2418-21.
10. Haas S, Acker D, Donahue C, Katz ME.Variation in hysterectomy rates across small geographic areas of Massachusetts. Am J Obstet Gynecol 1993;169(1):150-4.
11. Parazzini F, Mais V, Cipriani S, Busacca M, Venturini P; GISE. Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur J Obstet Gynecol Reprod Biol 2009;143(2):103-6
12. Parazzini FVP, Panazza S, Chatenoud L, Oldani S, Crosignani PG. Risk factors for adenomyosis. Hum Reprod 1997;12:1275–9.
13. Vercellini P, Vigano P, Somigliana E, Daguati R, Abbiati A, Fedele L. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 2006;20:465–77.
14. Levgur M, Abadi MA, Tucker A. Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol 2000;95:688–91.
15. Olive DL, Franklin RR, Gratkins LV. The association between endometriosis and spontaneous abortion. A retrospective clinical study. J Reprod Med 1982;27:333–8.
16. Vercellini P, Parazzini F, Oldani S, et al. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod 1995;10:1160–2.
17. Azziz R. Adenomyosis in pregnancy. A review. J Reprod Med 1986;31:224–7.
18. Merrill JA, Creasman WT. Disorders of the uterine corpus. In: Scott JR, Di Sala PJ, Hammond CB, et al., editors. Danforth’s obstetrics and gynecology. 6th ed., Philadelphia: Lippincott; 1990. p. 1023.
19. Taran FA, Weaver AL, Coddington CC, Stewart EA Understanding adenomyosis: a case control study. Fertil Steril 2010;94(4):1223–8.
20. Panganamamula UR, Harmanli OH, Isik-Akbay EF, Grotegut CA, Dandolu V, Gaughan JP. Is prior uterine surgery a risk factor for adenomyosis? Obstet Gynecol 2004;104:1034–8.
21. Takahashi K, Nagata H, Kitao M. Clinical usefulness of determination of estradiol level in the menstrual blood for patients with endometriosis. Nihon Sanka Fujinka Gakkai Zasshi 1989;41(11):1849-50.