••• Chapter 25^ Adenomyosis and Endometriosis^255
❍ Describe the diathesis-stress model.
In the diathesis-stress model, a genetic vulnerability or predisposition (diathesis) interacts with the environment
and life events (stressors) to trigger behaviors or psychological disorders.
❍ What class of medications has now supplanted narcotics as a treatment of chronic pelvic pain?
Heterocyclic antidepressants.
❍ Based on a recent review of 500 consecutive cases by Shaw, what pelvic structure has a higher incidence of
implants than the ovary?
Uterosacral ligaments.
❍ As a woman with endometriosis ages, her endometriotic lesions change from clear papules to __.
Black.
❍ Who was the first person to describe adenomyosis in the medical literature?
Rokitansky, in 1860.
❍ What is the definition of adenomyosis?
The presence of endometrial glands and stoma within the myometrium with compensatory hypertrophy of
the myometrium (most articles today used a depth of 3 mm, or 1 low-powered field, below the basal layer of
endometrium as the required depth of invasion). It has an incidence of 31% to 61%.
❍ True or False: Adenomyosis appears equally in parous and nulliparous women.
False. It has been correlated with increasing parity.
❍ What are the four theories of causality of adenomyosis?
(1) Heredity.
(2) Trauma.
(3) Hyperestrogenemia.
(4) Viral transmission.
❍ Name the most common symptom in patients with adenomyosis.
Abnormal uterine bleeding, secondary dysmenorrhea, and enlarged and tender uterus (but up to 35% may be
asymptomatic).