Endometriosis vs Adenomyosis and fibroids
How to tell Endometriosis and Adenomyosis and fibroids apart when a board question makes them look alike.
Endometriosis is ectopic implants with infertility and dyspareunia; adenomyosis is boggy painful uterus; fibroids are firm irregular uterine masses.
Side by side
Endometriosis causes cyclic pelvic pain, dysmenorrhea, dyspareunia, infertility, and ectopic endometrial glands/stroma outside the uterus.
Adenomyosis causes heavy painful menses with a diffusely enlarged boggy uterus; fibroids cause abnormal bleeding, bulk symptoms, and firm irregular uterine masses.
Ectopic endometrial tissue responds to hormones, bleeds cyclically, and causes inflammation, adhesions, and endometriomas.
Adenomyosis is endometrial glands within myometrium; fibroids are estrogen-sensitive smooth muscle leiomyomas.
Laparoscopy with powder-burn lesions, ovarian chocolate cysts, adhesions, and biopsy showing glands/stroma support endometriosis.
Boggy tender enlarged uterus supports adenomyosis; ultrasound showing well-circumscribed leiomyomas supports fibroids.
The trap
All can cause pelvic pain or bleeding, so uterine exam, lesion location, and infertility pattern separate them.
The repair move
For pelvic pain and bleeding, decide whether pathology is outside uterus, inside myometrium, or a smooth muscle mass.
Try a free question
CoreA 28-year-old G0 has 3 years of progressive cyclic pelvic pain peaking with menses, deep dyspareunia, and primary infertility. Pelvic exam reveals nodularity in the posterior cul-de-sac and a tender uterosacral ligament. Laparoscopy shows multiple powder-burn lesions on the peritoneum and a 4 cm endometrioma on the right ovary. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Endometriosis. Endometriosis is ectopic endometrial glands and stroma outside the uterus; the triad of cyclic pelvic pain, dyspareunia, and infertility with laparoscopic powder-burn lesions and endometrioma is classic.
Why the other choices are tempting
- B. Adenomyosis is endometrial glands within the myometrium, producing a diffusely enlarged boggy tender uterus with heavy painful menses, not ovarian endometrioma.
- C. Uterine fibroids produce abnormal bleeding and bulk symptoms with well-circumscribed myometrial masses, not powder-burn peritoneal lesions.
- D. PID would have fever, cervical motion tenderness, and STD exposure; the chronic cyclic pattern is endometriosis.
- E. Functional ovarian cysts resolve over a menstrual cycle and do not cause chronic peritoneal disease.
Flashcards
Tap a card to flip it.
What laparoscopic clue supports endometriosis?
Powder-burn implants or chocolate cysts support endometriosis.
What exam finding supports adenomyosis?
A diffusely enlarged boggy tender uterus supports adenomyosis.
Quick answers
What is the fastest way to tell Endometriosis from Adenomyosis and fibroids?
Endometriosis is ectopic implants with infertility and dyspareunia; adenomyosis is boggy painful uterus; fibroids are firm irregular uterine masses.
What is the key clue for Endometriosis?
Endometriosis causes cyclic pelvic pain, dysmenorrhea, dyspareunia, infertility, and ectopic endometrial glands/stroma outside the uterus.
What is the key clue for Adenomyosis and fibroids?
Adenomyosis causes heavy painful menses with a diffusely enlarged boggy uterus; fibroids cause abnormal bleeding, bulk symptoms, and firm irregular uterine masses.
What is the common trap with Endometriosis vs Adenomyosis and fibroids?
All can cause pelvic pain or bleeding, so uterine exam, lesion location, and infertility pattern separate them.