Norwegian Adenomyosis Study I
Norwegian Adenomyosis Study I
Adenomyosis is characterized by the appearance of endometrial cells in the muscular layer of
 the uterus. It affects about 15-20% of the female population.

 The symptoms of adenomyosis are heavy menstrual bleedings and painful menstruation
 (dysmenorrhea) and in addition chronic pelvic pain. Subfertility and infertility have been
 correlated with adenomyosis.

 Parity, age and uterine abrasion increase the risk of adenomyosis. Hormonal factors such as
 local hyperestrogenism and elevated levels of prolactin have been identified, but autoimmune
 and mechanical factors are also hypothesized.

 Regarding treatment, the most effective measure is hysterectomy. As this is a very drastic
 measure in younger women, levonogestrel-releasing intrauterine devices, Gonadotropin
 releasing hormone (GnRH)-analogues, Danazol, uterine embolization and endometrial ablation
 have been tried, but studies are few in number, retrospective, and have small sample sizes.

 Adenomyosis has so far not been subject to extensive research efforts. The pathogenesis of
 adenomyosis remains still unclear, there are not many satisfying treatment options and
 diagnostics include mostly magnetic resonance imaging (MRI) and histology.

 The investigators designed a series of 3 studies with a broad approach in understanding
 adenomyosis. This is part 1.

 NAPPED-1: comparison of 3D-transvaginal ultrasound with MRI and histology in the diagnostic
 of adenomyosis
Diagnosis of Adenomyosis with 3D and 2D transvaginal ultrasound. Prospective study of a
 consecutive series of 101 patients that are scheduled for hysterectomy and suffer from
 bleeding disorders, chronic pelvic pain, dysmenorrhea or dyspareunia. All patients will
 undergo transvaginal 2D- ultrasound, 3D-ultrasound and power doppler (PD)-ultrasound (TVU),
 magnetic resonance imaging of the pelvic organs (MRI) and hysterectomy.

 We will investigate the specificity and sensitivity of 3D and 2D transvaginal ultrasound in
 the diagnosis of adenomyosis and compare data with MRI and histopathology, which is the gold
 standard by today. In addition, we will collect anamnestic information that might point to
 risk factors or connections to prior obstetrical complications and medicine use. In our study
 the pathologist will not be blinded to our ultrasound findings, and we want to investigate if
 this will raise the sensitivity of histology findings of adenomyosis.
Inclusion Criteria:

 -  Premenopausal women aged 30 - 50 years old

 -  scheduled for vaginal, abdominal or laparoscopic total hysterectomy

 -  one or more of the following clinical symptoms: bleeding disorders (menorrhagia,
 irregular bleeding, hypermenorrhoea), chronic pelvic pain, dysmenorrhoea, or
 dyspareunia

 -  junction zone definable

 Exclusion Criteria:

 -  postmenopausal women,

 -  pregnancy

 -  gynecological cancer

 -  GnRH analog therapy or systemic hormone therapy in the last three months prior to
 hysterectomy

 -  junctional zone not identifiable