The Value of Adenomyosis Type in Clinical Assessment: A Single-center Experience of 755 Nodular and Diffuse Adenomyosis Cases

To investigate the incidence of nodular and diffuse adenomyosis, concomitant pathologies and also to compare the demographic and clinic differences among patients with adenomyosis and their surgery indications. Methods: This retrospective study was conducted in Tepecik Research Hospital, Izmir, Turkey between 2014 and 2016. Patients were divided into two groups of nodular and diffuse adenomyosis. The following variables were evaluated for both groups: age, gravidity, parity, menopausal status, indication for hysterectomy, ultrasonographic parameters, gynecological symptoms (abnormal uterine bleeding [AUB], pelvic pain and pelvic pressure, postmenopausal vaginal bleeding), preoperative and postoperative histopathological assessment, and coexisting pathologies. Results: Of the total 3457 cases of hysterectomies, 755 (95% CI: 20.4–23.1) were confirmed with adenomyosis. There were 217 (95% CI: 23.9–30.0) postmenopausal women. Adenomyosis was most commonly detected in patients in the age of 40 to 50 (57.6%). The most common symptoms were AUB (n: 336) (95% CI: 40.9–48.0), pelvic pain or pressure (n:139) (18.4%), and postmenopausal vaginal bleeding (n: 119) (95% CI: 13.1–18,4). Seventy-four (95% CI: 7.9–11.9) of the patients had nodular and 681(95% CI: 88.0–92.3) had diffuse adenomyosis. Demographic data, age, parity, gravidity, endometrial thickness, and menopausal status were similar between the groups. AUB was more frequently detected in nodular adenomyosis (56.8%). Myoma uteri was the main hysterectomy indication in both groups. In addition, treatment-resistant AUB for nodular adenomyosis and endometrial pathologies for diffuse adenomyosis were the most frequent indications for hysterectomy after myoma uteri. Conclusion: The most common form of adenomyosis was the diffuse form. Endometrial pathologies were more frequently associated with diffuse adenomyosis. Asymptomatic and incidental adenomyosis were more common with the diffuse form. AUB was more frequently detected with nodular adenomyosis.