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 features

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