Published: 2021-08-25

Prevalence of adenomyosis and associated gynaecological pathologies in hysterectomy samples: a retrospective study

Lekshminath Gopinath, Rajani Vaidya


Background: Adenomyosis is a prevalent gynaecological disorder among women and it is a major cause for AUB. Its diagnosis is confirmed by histological examination of hysterectomized samples. Moreover it is associated with other benign gynaecological pathologies. The aim of this study is to identify the prevalence of Adenomyosis and its association with other benign gynaec pathologies in hysterectomized samples.

Methods: This retrospective of two year duration was conducted in obstetrics and Gynaecology department of Malabar Medical College Hospital and Research Centre, a tertiary care centre in Kozhikode, Kerala from 2019 June to 2021 June. 452 patients underwent hysterectomy for abnormal uterine bleeding during this period. Among this, 76 patients had histologically proven adenomyosis in hysterectomy specimen and their case record were reviewed and the data was analysed.

Results: The prevalence of Adenomyosis in this study was 16.8%. Majority of women were in age group of 41 to 46 (36.8%), followed by 46 to 50 age group (26.3%). 94 % of women were multipara with majority in para2 and para3 group. Only 6 % of women were nulliparous. Most common symptom was abnormal uterine bleeding (92%), followed by dysmenorrhoea and chronic pelvic pain. Majority had overlap of symptoms. 7% of women were asymptomatic. In 60 % of women no other gynaec pathologies were identified. Most common associated pathology was leiomyoma (15.8%), closely followed by endometriosis (13.2%). Endometrial hyperplasia was associated with adenomyosis in 3.9%of women and endometrial polyp in 2.6%. Ovarian pathologies identified were simple ovarian cyst (2.6%) and serous cystadenoma (1.3%).

Conclusions: In the present study, the prevalence of adenomyosis was high and abnormal uterine bleeding was the patients’ most prevalent complaint. Among the associated gynaec pathologies, leiomyoma had the highest correlation with adenomyosis.


Adenomyosis, AUB, Hysterectomy, HPE

Full Text:



McCluggage WG, Robboy SJ. Mesenchymal uterine tumours, other than pure smooth muscle neoplasms, and adenomyosis. In: Robboy SJ, Mutter GL, Prat J, et al.: (Eds), editor. Robboy’s pathology of the female reproductive tract (second edition) Churchill Livingstone Elsevier. 2009;427-56.

Benagiano G, Broses I, Lippi D. The history of endometriosis. Gynaecologic and obstetric investigation. 2014.

Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecology. 2006;20(4):547-55.

Leyendecker G, Bilgicyildirim A, Inacker M. Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Arch Gynecol Obstet. 2015;291(4):917-32.

Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: state of the art. Best Practice Clinical Obstetrics Gynaecology. 2018;51:16-24.

Agostinho L, Cruz R, Osorio F, Alves J, Setubal A, Guerra A. MRI for adenomyosis: a pictorial review. Insights Imaging. 2017;8:549-56.

Vannuccini S, Luisi S, Tosti C. Role of medical therapy in the management of uterine adenomyosis. Fertil. 2018;109(3):398-405.

Reinhold C, Tafazoli F, Wang L. The imaging features of adenomyosis. Hum Reprod Update 1998;4:37-49.

Cunningham RK, Horrow MM, Smith RJ, Springer J. Adenomyosis: a sonographic diagnosis. Radiographics. 2018;38(5):1576-89.

Hanafi M. Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation. J Hum Reprod Sci. 2013;6(3):189-93.

Yeniel O CT, Ulukus M, Ozbal A, Gundem G, Ozsener S, Zekioglu O et al. Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Clin Experimental Obstet Gynaecol. 2007;34(3):163-7.

Shivananjiah C, Nayak A, Swarup A, Honappa S, Swaminathan KR, Pathadan DS. Histopathological pattern of endometrium in Adenomyosis. Indian Journal of Obstetrics and Gynaecology Research. 2016;3(2):101-3.

Ali A. The incidence of adenomyosis in hysterectomies. Pak J Med Res. 2005;44:38-40.

Khreisat B, Al-Rawabdeh S, Duqoum W. Adenomyosis: the frequency of hysterectomy in the histopathological specimens at two Jordanian military hospitals JRMS 2011; 18(2): 76-79 PDF. assay. J Clin Pathol. 1985;38:694-700.

Graziano A, Lo Monte G, Piva I. Diagnostic findings in adenomyosis: a pictorial review on the major concerns. Eur Rev Med Pharmac Sci. 2015;19(7):1146-54.

Shivananjiah C, Nayak A, Swarup A, Honappa S, Swaminathan KR, Pathadan DS. Histopathological pattern of endometrium in Adenomyosis. Indian Journal of Obstetrics and Gynaecology Research. 2016;3(2):101-3.

Templeman C, Marshall SF, Ursin G, Horn-Ross PL, Clarke CA, Allen M, et al. Adenomyosis and endometriosis in the California Teachers Study. Fertility and sterility. 2008;90(2):415-24.

Choi EJ. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci. 2017;60:579-86.

Verit FF, Yucel O. Endometriosis, Leiomyoma and Adenomyosis: the risk of gynaecologic malignancy. Asian Pac J Cancer Prev. 2013;14(10):5589-97.

Vercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani PG. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod. 1995;10:1160-2.