Risk factors for adenomyosis, leiomyoma and concurrent adenomyosis and leiomyoma.

Aim: To evaluate the risk factors for adenomyosis, leiomyoma and concomitant adenomyosis and leiomyoma in patients with treatment-resistant menometrorrhagia.

Methods: A retrospective study was conducted on 129 women who underwent abdominal hysterectomy for treatment-resistant menometrorrhagia. The patients were divided into four groups according to the postoperative histopathology: concomitant adenomyosis and leiomyoma (n = 33), adenomyosis only (n = 26), leiomyoma only (n = 48) and controls (n = 22). Patients without any organic uterine pathology constituted the control group.

Results: Age at menarche was higher in the concomitant adenomyosis and leiomyoma group compared to the adenomyosis only group (P = 0.006). The mean age (P = 0.007), age at menarche (P = 0.001) and gravidity (P = 0.001) were higher in the concomitant adenomyosis and leiomyoma group compared to the leiomyoma only group. Preoperative hemoglobin was lower in the concomitant adenomyosis and leiomyoma, adenomyosis only, and leiomyoma only groups than the control group (P < 0.008). On receiver operating characteristic analysis, hemoglobin <10.9 mg/dL had a sensitivity and specificity of 77% and 70%, respectively, in discrimination of any uterine organic pathology, including adenomyosis only, leiomyoma only, and concomitant adenomyosis and leiomyoma, from the control group. Patients in the adenomyosis group were older (OR, 1.20; 95%CI: 1.05-1.50) and had a lower age at menarche (OR, 0.42; 95%CI: 0.19-0.89) than the other groups.

Conclusions: Preoperative anemia may be a useful predictor of adenomyosis. Older patients, and patients who had a lower age at menarche, were also more likely to have adenomyosis.