EC Gynaecology

Adenomyosis is a common benign gynaecological disorder often necessitating hysterectomy for disturbing symptoms of heavy menstrual bleeding and/or dysmenorrhoea. In diffuse adenomyosis, uterus becomes globular and enlarges to about 12 weeks gestation uterine size. During the pandemic, our team operated on fourteen cases of adenomyosis, in six of which the uterus was enlarged to more than 12 weeks gestation, with the largest being 22 weeks gestation size. With patients delaying elective surgeries due to the COVID-19 pandemic, will new size criteria for adenomyosis emerge in the future?

Keywords: Adenomyosis; COVID-19 Pandemic; Hysterectomy; Endometriosis; Heavy Menstrual Bleeding; Leiomyoma; Dysmenorrhoea; Large Uterus; AUB-A

1. Levgur M. “Diagnosis of adenomyosis: A review”. The Journal of Reproductive Medicine3 (2007): 177-193.
2. Czeiser ME., et al. “Delay or Avoidance of medical care because of COVID-19 related concerns – United States”. Morbidity and Mortality Weekly Report69 (2020): 1250-1257.
3. Rachel R., et al. “Delays and disruptions in cancer health care due to COVID-19 pandemic: Systematic review”. Global Oncology 7 (2021): 311-323.
4. Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency. Preprint”. Med Rxiv (2020).
5. Li Z., et al. “Effect of COVID-19 Pandemic on diagnosis and treatment delays in urological disease: Single-institution experience”. Risk Management and Healthcare Policy 14 (2021): 895-900.
6. Brosens I., et al. “Uterine cystic adenomyosis: A disease of younger women”. Journal of Pediatric and Adolescent Gynecology6 (2015): 420-406.
7. Weiss G., et al. “Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN)”. Fertility and Sterility 91 (2009): 201.
8. Panganamamula UR., et al. “Is prior uterine surgery a risk factor for adenomyosis?” Obstetrics and Gynecology 104 (2004): 1034-1038.
9. Parker JD., et al. “Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis”. Fertility and Sterility 86 (2006): 711.
10. Younes G and Tulandi T. “Effects of adenomyosis on in vitro fertilization treatment outcomes: A meta-analysis”. Fertility and Sterility3 (2017): 483-490.
11. Liu L., et al. “Diagnostic accuracy of transvaginal ultrasound and magnetic resonance imaging for adenomyosis: Systematic review and meta-analysis and review of sonographic diagnostic criteria”. Journal of Ultrasound in Medicine11 (2021): 2289-2306.
12. Stewart EA. Uterine adenomyosis (2022).
13. Di Donato N., et al. “Prevalence of adenomyosis in women undergoing surgery for endometriosis”. European Journal of Obstetrics and Gynecology and Reproductive Biology 181 (2014): 289-293.
14. Brucker SY., et al. “Clinical characteristics indicating adenomyosis coexisting with leiomyomas: A retrospective, questionnaire-based study”. Fertility and Sterility1 (2014): 237-241.
15. Osada H. “Uterine adenomyosis and adenomyoma: The surgical approach”. Fertility and Sterility3 (2018): 406-417.
16. Harmanli OH., et al. “A case of adenomyosis per se with a uterine weight of 475 g”. Gynecologic and Obstetric Investigation4 (2004): 216-218.