1. Adenomysis is the growth of endometrial glands and stroma in the uterine myometrium at a  depth of at least 2.5mm from the basalis layer of the endometrium. These glands do not   usually undergo the traditional cyclic proliferative and secretory changes that are associated  with differing levels of ovarian hormone production. The uterine posterior wall is usually  involved more than the anterior wall. In the more common, diffuse type of adenomyosis the  uterus is uniformly enlarged, usually 2 to 3 times normal size.

2. The incidental may exceed 60% in women 40 to 50 years of age.

3. Some studies have demonstrated a lack of progesterone receptors in tissue from adenomyosis and fewer estrogen receptors than normal endometrium.       

Clinical Diagnosis

Symptoms and signs:

1. The majority of women with adenomyosis are asymptomatic or minor symptoms.

2. Symptomatic adenomyosis usually presents in women between the ages of 35 and 50, and  the majority women are parous and frequently have several children.

3. The clinical symptoms of adenomyosis are secondary dysmenorrhea and menorrhagia, dyaparareunia.

 Diagnosis:

1. Adenomysis is a clinical diagnosis and imaging studies, although helpful are not definitive .

2. In women with diffuse uterine enlargement and negative pregnancy test. Secondary    

3.   dysmenorrhea may be attributed to adenomyosis.

4. Suspected adenomyosis can be confirmed pathologically only at the time of hysterectomy. The clinical diagnosis was confirmed in only 48% of cases. 

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Management:

1. There is no satisfactory medical treatment for adenomyosis,

2. Patients can be treated with cyclic hormones or prostaglandin synthetase inhibitors for their   abnormal bleeding and pain.

3. Hysterectomy is the definitive treatment if this therapy is appropriate for women¡¦s age, parity, and plans for future reproduction.