See also BIRTH DEFECTS; CHILDBIRTH; CHROMOSOMAL
DISORDERS; CONTRACEPTION; ECTOPIC PREGNANCY; FAM-
ILY PLANNING; GENETIC DISORDERS; NEURAL TUBE
DEFECTS; STILLBIRTH.
adenomyosis A condition in which the cells that
make up the endometrium (the lining of the
UTERUS) grow into the wall of the uterus
(myometrium), forming benign (noncancerous)
tumors that appear as thickenings or masses con-
tained within the uterine wall. Adenomyosis
nearly always occurs in women who have carried
pregnancies to full term, causing doctors to believe
the condition results from injury to the wall of the
uterus as it stretches to accommodate the growth
of the FETUSin the final weeks of PREGNANCY.
Adenomyosis may not cause symptoms; the
doctor may discover its presence during evalua-
tion for other health conditions affecting the
uterus, such as DYSFUNCTIONAL UTERINE BLEEDING
(DUB) orENDOMETRIOSIS. The uterus may be tender
to palpation (examination by touching) during
PELVIC EXAMINATION. When symptoms do occur they
may include PAIN during SEXUAL INTERCOURSE,
unusually heavy menstrual bleeding, and intense
menstrual cramping.
The diagnostic path may include ULTRASOUND,
COMPUTED TOMOGRAPHY(CT) SCAN, orMAGNETIC RESO-
NANCE IMAGING(MRI), though definitive diagnosis
requires myometrial biopsy (laboratory examina-
tion of a tissue sample from the uterine wall). The
gynecologist may use HYSTEROSCOPYto obtain the
biopsy, or may examine tissue obtained through
procedures to treat DUB such as DILATION AND
CURETTAGE(D&C).
The monthly surge of hormones that cause the
endometrium to thicken is responsible for symp-
toms; the engorged endometrial tissue causes
pressure where it has infiltrated the myometrium.
Because this hormonal cycle ends with MENOPAUSE
(cessation of the menstrual cycle), adenomyosis
then goes away. Treatment thus attempts to
relieve symptoms until menopause occurs and
may include NONSTEROIDAL ANTI-INFLAMMATORY
DRUGS(NSAIDS) or oral contraceptives (birth control
pills) to regulate the hormonal balance that con-
trols the MENSTRUAL CYCLE. When symptoms are
severe and the woman does not desire further
pregnancies, HYSTERECTOMY(surgery to remove the
uterus) may be a treatment option. Because the
infiltration into the myometrium is diffuse (spread
out), it is not possible to surgically remove only
the sites of adenomyosis. Adenomyosis does not
affect FERTILITYor the capability of the uterus to
again expand in pregnancy.
See also CONTRACEPTION; DYSMENORRHEA; ENDOME-
TRIAL CANCER; ENDOMETRIOSIS; UTERINE FIBROIDS.adoption Accepting or relinquishing legal,
social, and family responsibilities for a nonbiologic
child. Adoption is an option within FAMILY PLAN-
NINGfor people who desire children. Placing a
child for adoption also an option in a circumstance
of an unplanned PREGNANCY. About 150,000 adop-
tions take place in the United States each year.
Adoptions may be open, in which there is direct
or indirect contact between the biologic parents
and the adoptive parents, or closed, in which the
court seals the adoption records and biologic and
adoptive parents do not know each other or any-
thing about each other.
Each state in the United States has its own laws
and procedures that regulate both sides of the
adoption process. However, all states recognize
and honor legal adoptions made in other states.
Adoption laws regulate factors such as what infor-
mation may be (or in some states, must be) made
available to adult adopted children, the legal rights
of biologic and adoptive parents, and the rights of
biologic fathers who do not know their children
were relinquished for adoption.
Countries around the world have their own
laws and procedures for adoption that may or may
not be consistent with practices in the United
States. Though the United States generally recog-
nizes foreign adoptions, federal immigration laws
require specific evidence of legal adoption and
other documentation. The US Department of State
handles such matters. No matter the state or
country, the legal issues of adoption are complex.
It is prudent to obtain advice from a qualified
adoption attorney before proceeding.Health Concerns in Adopting a Child
Many adopted children come to their adoptive
families with health concerns. Though it is ideal to
have a full health history, including family history,
for the adopted child, this does not often happen.adoption 241