The presence of functional endometrial tissue within the myometrium of the uterus
Aetiology
Thought to occur when the endometrium is allowed to communicate with the underlying myometrium after uterine damage; such interaction may occur in association with:
Pregnancy and childbirth
Caesarean section
Uterine surgery (e.g endometrial curettage)
Surgical management of miscarriage or termination of pregnancy
Clinical presentation
Symptoms
Menorrhagia
Dysmenorrhoea
Deep dyspareunia
Irregular bleeding
Signs
Symmetrically enlarged tender uterus
Investigations
Definitive diagnosis is through biopsy after hysterectomy
Imaging can assist diagnosis - transvaginal US, MRI
Management
Hysterectomy is the only curative therapy
Other more conservative approaches may give symptom control:
Combined oral contraceptives
Progestogens (oral or intrauterine system e.g. Mirena)
GnRH analogues
Aromatase inhibitors
Uterine artery embolisation can be used as an alternative treatment option in the short and medium term for women who wish to avoid hysterectomy/preserve their fertility
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