title: Is adenomyosis associated with menorrhagia?
abstract: OBJECTIVE
  Is the presence of adenomyosis associated with menorrhagia?
  
  
  CONCLUSIONS
  There was no significant association between adenomyosis and menorrhagia, but there was a significant positive correlation between the severity of adenomyosis on ultrasound and the amount of menstrual loss estimated using pictorial blood loss assessment charts.
  
  
  BACKGROUND
  There is no consensus in the literature with regards to the association between adenomyosis and menorrhagia. Previous studies have been limited to retrospective studies of highly selected populations which mainly included women who underwent hysterectomy. There are no large prospective studies evaluating the association between adenomyosis and menorrhagia, either in the general population of women or in a general gynaecology clinic setting.
  
  
  METHODS
  This was a prospective observational study set in the general gynaecology clinic of a university teaching hospital between January 2009 and January 2010.
  
  
  METHODS
  There were 714 consecutive premenopausal women who attended the clinic and underwent structured clinical and transvaginal ultrasound examination in accordance with the study protocol. Morphological features of adenomyosis were systematically recorded on ultrasound scan. Menorrhagia was determined subjectively by direct questioning and objectively by completion of pictorial blood loss analysis charts.
  
  
  RESULTS
  A diagnosis of adenomyosis was made in 157/714 women [22.0% (95% CI: 19.1-25.2%)]. Multivariable analysis showed significant associations between submucous fibroids [OR 5.60 (95% CI: 2.69-11.6)], any fibroids [OR 1.53 (95% CI: 0.91-2.58)] and endometrial polyps [OR 2.81 (95% CI: 1.15-11.7)] and menorrhagia. There were also significant associations between increasing gravidity and BMI and menorrhagia (P < 0.01). There was no significant association between adenomyosis and menorrhagia in the study population, when adenomyosis was assessed as a binary outcome. When severity of adenomyosis was assessed by counting the number of morphological features of adenomyosis in each woman, we found a significant 22% increase in menstrual loss for each additional feature of adenomyosis [OR 1.21 (95% CI: 1.04-1.40)].
  
  
  CONCLUSIONS
  A classification of severity of adenomyosis based on the number of ultrasound features present is a novel concept that should be prospectively evaluated in different populations.
  
  
  CONCLUSIONS
  A better understanding of the relationship between adenomyosis and menorrhagia can help improve counselling of women regarding the significance of this common condition and facilitate future studies assessing the effectiveness of different conservative treatments protocols.
  
  
  BACKGROUND
  The authors have no competing interests. The study was not supported by an external grant.
authors.affiliation: Gynaecology Diagnostic and Outpatient Treatment Unit, University College Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Naftalin
authors.forename: W
authors.initials: W
authors.lastname: Hoo
authors.forename: K
authors.initials: K
authors.lastname: Pateman
authors.forename: D
authors.initials: D
authors.lastname: Mavrelos
authors.forename: X
authors.initials: X
authors.lastname: Foo
authors.forename: D
authors.initials: D
authors.lastname: Jurkovic
mesh_terms: D062788:Adenomyosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000150:complications / Q000209:etiology*; D014463:Ultrasonography
keywords: adenomyosis; menorrhagia; transvaginal ultrasound