Adenomyosis: Understanding the Condition After Hysterectomy

Question
Hello Dr. Rappaport.  It's Jayne Sena.  I wrote to you a few weeks back about having a hysterectomy due to uncontrollable bleeding.  I have 4 children and have had a tubal.  Well, I had the hysterectomy 10 days ago and I feel great already! I am a bit sore at the incision site, but I am on the mend.  My doctor told me that pathology said I had severe adenomyosis.  Exactly what is that (in layman's terms)  and could the cause have been from a trauma to my uterus?  I hemorrhaged when I had my twins and was "worked" on for at least an hour during that time. Any input is grately appreciated.  Thank you so much - Jayne  

Answer
Adenomyosis typically affects  women in the fourth and fifth decades of life, and 30% of cases are asymptomatic. The most common presenting complaint is abnormal uterine bleeding, The diagnosis is made histopathologically when endometrial stroma and glands are observed at least 2-3 millimeters below the endometrial surface (the inner wall of the uterus)within the myometrium (the muscle layer of the uterus). The cause of the pain associated with adenomyosis is not known. Hysterectomy has consistently been shown  to be successful in treating and controlling the symptoms associated with adenomyosis. Your history of previous trauma to your uterus would not have had any relation to your development of adenomyosis. It is common to have post partum hemorrhage after a twin delivery due to an atonic uterus (due to the stretching that occurred throughout the twin pregnancy).