What is the difference between uterine fibroids and adenomyosis?

The difference between uterine fibroids and adenomyosis is mainly reflected in the pathogenesis, symptom manifestations and treatment methods. Uterine fibroids are benign tumors formed by the proliferation of uterine smooth muscle tissue, while adenomyosis is a lesion caused by the invasion of endometrial tissue into the myometrium.

1. Pathogenesis

Uterine fibroids are formed by abnormal proliferation of smooth muscle cells and are closely related to elevated estrogen levels. They are mostly solitary masses with clear borders. Adenomyosis is a special type of endometriosis in which endometrial glands and stroma invade the myometrium, causing thickening and fibrosis of the myometrium, and blurring the boundaries between the lesions and surrounding tissues.

2. Symptoms

Uterine fibroids often cause increased menstrual flow, prolonged menstruation, or compression symptoms such as frequent urination and constipation. Most of them do not have dysmenorrhea. The core symptom of adenomyosis is progressive aggravation of dysmenorrhea. Along with increased menstrual volume and prolonged menstrual period, some patients develop dyspareunia and chronic pelvic pain. Ultrasound examination shows uniform enlargement of the uterus.

3. Imaging characteristics

On ultrasonography, uterine fibroids appear as round-like hypoechoic masses with pseudocapsules around them and blood flow signals distributed in a ring. Adenomyosis shows thickening of the myometrium with uneven echoes, punctate anechoic areas, no clear boundary between the lesions and the myometrium, and diffuse enhancement of blood flow signals.

4. Pathological diagnosis

The pathology of uterine fibroids shows that spindle smooth muscle cells are arranged in bundles with consistent cell morphology and rare mitoses. The pathology of adenomyosis shows that the endometrial glands and stroma penetrate deep into the myometrium, and the surrounding muscle cells hypertrophy, often accompanied by bleeding and hemosiderin deposition.

5. Treatment methods

Asymptomatic uterine fibroids can be observed. Medications are commonly used, such as mifepristone tablets and Guizhi Fuling capsules. Myomectomy is an option for surgery. Adenomyosis requires long-term management, and gonadotropin-releasing hormone agonists such as leuprolide microspheres are the first choice. Conservative surgery is prone to recurrence, and radical treatment requires hysterectomy.

It is recommended that patients undergo regular gynecological examinations, avoid strenuous exercise during menstruation, and keep the perineum clean. Seek medical attention promptly when abnormal bleeding or dysmenorrhea worsens, choose an individualized treatment plan based on age, fertility needs, and severity of illness, and avoid taking hormone drugs on your own.