Leiomyomas vs Adenomyosis

Uterine Fibroids (Leiomyomas)

These are well-circumscribed, benign tumors of myometrial smooth muscle found in the uterus.

• Women >35 years, especially African American women
• Estrogen-sensitive (grow during pregnancy, shrink after menopause)

Symptoms:

• Heavy menstrual bleeding (menorrhagia)
• Pelvic pressure or pain
• Constipation, urinary frequency (mass effect)
• Reproductive issues (infertility, miscarriage risk)
• Irregularly enlarged, firm, nontender uterus
  • “Lumpy-bumpy” or “cobblestone” feel

Imaging:

• Pelvic ultrasound → discrete, solid masses in uterus
• May show calcifications, shadowing

Treatment:

• Medical: OCPs, GnRH agonists (e.g., leuprolide)
• Surgical:
  • Myomectomy (fertility preservation)
  • Hysterectomy (definitive)
  • Uterine artery embolization (UAE)

Adenomyosis

Ectopic endometrial glands and stroma within the uterine muscle wall.

• Multiparous women aged 35-50
• Often with dysmenorrhea and menorrhagia

Symptoms:

• Heavy, painful periods
• Chronic pelvic pain
• Pain often worsens with menses
• May have dyspareunia
• Uniformly enlarged, soft, globular, tender uterus

Imaging:

• MRI or transvaginal ultrasound may show thickened myometrium
• Definitive diagnosis: Histology post-hysterectomy

Treatment:

• Medical: OCPs, progestins, NSAIDs, GnRH agonists
• Definitive: Hysterectomy (only curative option)