Histological evaluation of the prevalence of adenomyosis, myomas and of their concomitance.

BACKGROUND: The objective of this study is to evaluate the prevalence of adenomyosis, leiomyomas and of their concomitance in women who underwent hysterectomy.

METHODS: An observational study carried out on a cohort of 347 women who underwent hysterectomy from a sample of 2383 patients who had gynecological surgery for benign disease in a single University Hospital between 2013 and 2016. An histological evaluation of all surgical specimens was carried out for the presence of adenomyosis and leiomyomas. Prevalence of adenomyosis alone, of leiomyomas alone or of their concomitance was evaluated.

RESULTS: In 140 women, indication to hysterectomy was an abnormal uterine bleeding, or pelvic pain (symptomatic), while in the remaining 207 hysterectomy was performed in postmenopausal women for uterine descent or concomitantly to ovariectomy. Mean age of women at hysterectomy was 47.7+5.3 yrs. and 68.9+7.9 yrs., respectively. Prevalence of adenomyosis (40% vs. 27%; p<0.0001) and of leiomyomas (70.7% vs. 50.7%; p<0.0001) was more frequent in symptomatic than post-menopausal women. Concomitant presence of adenomyosis and leiomyomas was also more prevalent in symptomatic than post- menopausal women (30% vs. 14%; p<0.0001). 75% uteri of symptomatic women with adenomyosis had also leiomyomas and 42.4% of those with leiomyomas has also adenomyosis.

CONCLUSIONS: In symptomatic women, adenomyosis and leiomyomas are frequent and coexist in 30% of cases. Coexistence of the two pathologies should be considered in women suffering of heavy menstrual bleeding and menstrual pain.