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Endometriosis and Adenomyosis

The main clinical distinction is that both conditions involve dysmenorrhea, but in endometriosis, the uterus is not enlarged and blue-violet nodules are present (not due to uterine enlargement itself), whereas in adenomyosis, there is uniform enlargement.

Endometriosis​

Overview​

  • Definition: Endometriosis (EMT) is characterized by the presence of viable endometrial tissue outside the uterine cavity and myometrium, typically elsewhere in the body.
  • Hormone-Dependent: Benign in nature but exhibits malignant behaviors such as implantation, infiltration, metastasis, and recurrence.

Histological Occurrence​

  • Implantation Theory.
  • Coelomic Epithelium Metaplasia Theory.
  • Stem Cell Origin Theory.

Etiology and Influencing Factors​

  • Genetics.
  • Immune System.
  • Estrogen.
  • In Situ Endometrium Determinism (unclear).

Pathology​

  • Can occur anywhere in the body, but predominantly in the pelvis. The ovaries are most commonly affected, followed by the uterosacral ligaments and rectovaginal pouch.
  • Under the influence of estrogen, repeated cyclical bleeding of ectopic endometrial tissue leads to the formation of purple-red or brown-yellow nodules.
  • Metaplasia and Neoplastic Transformation can occur, leading to conditions like endometrioid adenocarcinoma and clear cell carcinoma.

Clinical Presentation​

  • Symptoms:
    • Dysmenorrhea.
    • Infertility.
    • Dyspareunia.
    • Menstrual irregularities.
    • Acute abdominal pain.
  • Signs:
    • Rupture of large ovarian endometriotic cysts can cause peritoneal irritation.
    • Rectal examination may reveal a retroverted fixed uterus, with painful nodules palpable in the rectovaginal pouch, uterosacral ligaments, and lower segment of the posterior uterine wall.

Clinical Staging​

ASRM Staging:

StageDescriptionTotal Points
IMinimal1-5
IIMild6-15
IIIModerate16-40
IVSevere>40

Diagnosis​

  • Suspicion: Reproductive-age female + secondary dysmenorrhea progressively worsening + swelling not located in the uterus (combined with infertility, dyspareunia, etc.) + positive signs.
  • Auxiliary Tests:
    • Imaging: Transvaginal or abdominal ultrasound is preferred.
    • CA125: Elevated in severe cases, but usually not exceeding 100 U/ml.
    • Laparoscopy: Best diagnostic method.
  • Definitive Diagnosis: Pathology (biopsy during laparoscopy).

Treatment​

  • Symptomatic Relief: NSAIDs to alleviate abdominal pain.
  • Medication: To reduce the estrogen environment in the body.
    • Oral Contraceptives: "Pseudo-pregnancy therapy."
    • Gonadotropin-releasing hormone agonists (GnRH-a): (downregulation of receptors with long-term use) inhibits the secretion of pituitary gonadotropins.
  • Surgical Treatment:
    • Fertility-Preserving Surgery: For younger patients.
    • Ovarian Function-Preserving Surgery: For patients under 45 years old.
    • Radical Surgery: For severely ill patients nearing menopause who are over 45 years old.