Archives of Gynecology and Obstetrics

, Volume 289, Issue 6, pp 1235–1239 | Cite as

Differences in the clinical phenotype of adenomyosis and leiomyomas: a retrospective, questionnaire-based study

  • Bettina Boeer
  • Markus Wallwiener
  • Joachim Rom
  • Birgitt Schoenfisch
  • Sara Y. Brucker
  • Florin A. TaranEmail author
General Gynecology



To compare women undergoing laparoscopic hysterectomy with adenomyosis and women with leiomyomas.

Materials and methods

Retrospective and questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University Women’s Clinic, Tuebingen, Germany. The study sample comprised a total of 454 women who underwent hysterectomy for adenomyosis or leiomyomas and responded to the questionnaire; 52 (11.4 %) women with a histologic diagnosis of adenomyosis and 452 (88.6 %) women with a histologic diagnosis of leiomyomas.


Both groups of patients had enlarged uteri, but women with adenomyosis had a lower mean uterine weight as compared to women with leiomyomas (p < 0.001). Women with adenomyosis had significantly more pregnancies (p = 0.003), were more likely to have more than one pregnancy (p = 0.033) or more than one delivery (p = 0.025) as compared to women with leiomyomas. In addition, women with adenomyosis had a significantly higher surgical procedure score (p = 0.017), had more frequently a history of laparotomy (p = 0.042) and a history of Cesarean section as compared to women with leiomyomas only (p = 0.024). Significantly, more women with adenomyosis had pelvic pain or pressure as compared to women with leiomyomas (p = 0.045). We observed no differences between the two groups of patients regarding pelvic pain during the menstrual period, irregular menstrual periods, heavy bleeding, painful sexual intercourse and urination problems. Furthermore, we observed no differences in the therapeutic impact of the surgical procedure between the two patient groups.


Women with a histologic diagnosis of adenomyosis differ from women who have only leiomyomas at the time of hysterectomy.


Adenomyosis Leiomyomas 


Conflict of interest

We declare that we have no conflict of interest.


  1. 1.
    Ferenczy A (1998) Pathophysiology of adenomyosis. Hum Reprod Update 4(4):312–322PubMedCrossRefGoogle Scholar
  2. 2.
    Azziz R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 16(1):221–235PubMedGoogle Scholar
  3. 3.
    Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB (2001) Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 16(11):2418–2421PubMedGoogle Scholar
  4. 4.
    Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM (2009) Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the study of women’s health across the nation (SWAN). Fertil Steril 91(1):201–206PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Leyendecker G, Wildt L, Mall G (2009) The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 280:529–538PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Walker CL, Stewart EA (2005) Uterine fibroids: the elephant in the room. Science 308(5728):1589–1592PubMedCrossRefGoogle Scholar
  7. 7.
    Cong RJ, Huang ZY, Cong L, Ye Y, Wang Z, Zha L, Cao LP, Su XW, Yan J, Li YB (2012) Polymorphisms in genes HSD17B1 and HSD17B2 and uterine leiomyoma risk in Chinese women. Arch Gynecol Obstet 286:701–705PubMedCrossRefGoogle Scholar
  8. 8.
    Fernandez H, Farrugia M, Jones SE, Mauskopf JA, Oppelt P, Subramanian D (2009) Rate, type, and cost of invasive interventions for uterine myomas in Germany, France, and England. J Minim Invasive Gynecol 16(1):40–46PubMedCrossRefGoogle Scholar
  9. 9.
    Brill AI (2009) Treatment of fibroids via uterine artery occlusion (uterine artery embolization and Doppler-guided uterine artery occlusion): potential role in today’s armamentarium. Arch Gynecol Obstet 280:513–520PubMedCrossRefGoogle Scholar
  10. 10.
    Stewart EA (2001) Uterine fibroids. Lancet 357(9252):293–298PubMedCrossRefGoogle Scholar
  11. 11.
    Vercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani PG (1995) Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod 10(5):1160–1162PubMedGoogle Scholar
  12. 12.
    Vavilis D, Agorastos T, Tzafetas J, Loufopoulos A, Vakiani M, Constantinidis T, Patsiaoura K, Bontis J (1997) Adenomyosis at hysterectomy: prevalence and relationship to operative findings and reproductive and menstrual factors. Clin Exp Obstet Gynecol 24(1):36–38PubMedGoogle Scholar
  13. 13.
    Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG (1997) Risk factors for adenomyosis. Hum Reprod 12(6):1275–1279PubMedCrossRefGoogle Scholar
  14. 14.
    Parazzini F, Mais V, Cipriani S, Busacca M, Venturini P (2009) Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur J Obstet Gynecol Reprod Biol 143(2):103–106PubMedCrossRefGoogle Scholar
  15. 15.
    Taran FA, Weaver AL, Coddington CC, Stewart EA (2010) Understanding adenomyosis: a case control study. Fertil Steril 94(4):1223–1228PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Taran FA, Weaver AL, Coddington CC, Stewart EA (2010) Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod 25(5):1177–1182PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Taran FA, Wallwiener M, Kabashi D, Rothmund R, Rall K, Kraemer B, Brucker SY (2012) Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet 285(6):1571–1576PubMedCrossRefGoogle Scholar
  18. 18.
    Wallwiener M, Taran FA, Rothmund R, Kasperkowiak A, Auwarter G, Ganz A, Kraemer B, Abele H, Schonfisch B, Isaacson KB, Brucker SY (2013) Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations. Arch Gynecol Obstet. doi: 10.1007/s00404-013-2921-x PubMedCentralGoogle Scholar
  19. 19.
    Boosz A, Lermann J, Mehlhorn G, Loehberg C, Renner SP, Thiel FC, Schrauder M, Beckmann MW, Mueller A (2011) Comparison of re-operation rates and complication rates after total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH). Eur J Obstet Gynecol Reprod Biol 158(2):269–273PubMedCrossRefGoogle Scholar
  20. 20.
    Levgur M, Abadi MA, Tucker A (2000) Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol 95(5):688–691PubMedCrossRefGoogle Scholar
  21. 21.
    Panganamamula UR, Harmanli OH, Isik-Akbay EF, Grotegut CA, Dandolu V, Gaughan JP (2004) Is prior uterine surgery a risk factor for adenomyosis? Obstet Gynecol 104(5 Pt 1):1034–1038PubMedCrossRefGoogle Scholar
  22. 22.
    Vercellini P, Vigano P, Somigliana E, Daguati R, Abbiati A, Fedele L (2006) Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 20(4):465–477PubMedCrossRefGoogle Scholar
  23. 23.
    Lu HF, Sheu BC, Shih JC, Chang YL, Torng PL, Huang SC (1997) Intramural ectopic pregnancy. Sonographic picture and its relation with adenomyosis. Acta Obstet Gynecol Scand 76(9):886–889PubMedCrossRefGoogle Scholar
  24. 24.
    Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM (2002) The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99(2):290–300PubMedCrossRefGoogle Scholar
  25. 25.
    Peddada SD, Laughlin SK, Miner K, Guyon JP, Haneke K, Vahdat HL, Semelka RC, Kowalik A, Armao D, Davis B, Baird DD (2008) Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci USA 105(50):19887–19892PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Bettina Boeer
    • 1
  • Markus Wallwiener
    • 2
  • Joachim Rom
    • 2
  • Birgitt Schoenfisch
    • 1
  • Sara Y. Brucker
    • 1
  • Florin A. Taran
    • 1
    Email author
  1. 1.Department of Obstetrics and GynecologyUniversity Women’s ClinicTuebingenGermany
  2. 2.Department of Obstetrics and GynecologyUniversity Women’s ClinicHeidelbergGermany

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