Scribd Logo
Upload

Welcome to Scribd!

  • Risk Factors of Adenomyosis A Case Control Study in A Tertiary Care Hospital of Assam, India

    Uploaded by

    International Journal of Innovative Science and Research Technology
    16 views3 pages
    Adenomyosis is categorized under Non inflammatory disorder of the Female Genital tract in ICD10 classification

    Original Title

    Risk Factors of Adenomyosis a Case Control Study in a Tertiary Care Hospital of Assam, India

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Adenomyosis is categorized under Non inflammatory disorder of the Female Genital tract in ICD10 classification

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    16 views3 pages

    Risk Factors of Adenomyosis A Case Control Study in A Tertiary Care Hospital of Assam, India

    Uploaded by

    International Journal of Innovative Science and Research Technology
    Adenomyosis is categorized under Non inflammatory disorder of the Female Genital tract in ICD10 classification

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology

    ISSN No:-2456-2165

    Risk Factors of Adenomyosis: A Case Control Study


    in a Tertiary Care Hospital of Assam, India
    Dr. Mintu Dewri Bharalia, Dr. Arup Kumar Sarmab, Dr. Jayshree Goswamic,
    a,b
    Assistant Professor,cRegistrar,
    a
    Department of Community Medicine, bDepartment of Medicine, cDepartment of O&G,
    abc
    Gauhati Medical College, Guwahati,India.
    Corresponding Author: Dr Jayshree Goswami

    Abstract:- Adenomyosis is categorized under Non regarding the risk factors of diseases will always make the
    inflammatory disorder of the Female Genital tract in ICD- diagnostic and treatment strategies more effective.
    10 classification. It is defined as the benign invasion of
    endometrium into the myometrium, producing a diffusely A systematic review of Long term impact of
    enlarged uterus which microscopically exhibits ectopic Hysterectomy of literatures published between 2005 to 2020
    non-neoplastic, endometrial glands and stroma showed that hysterectomy may increase the risk of
    surrounded by the hypertrophic and hyperplastic cardiovascular events, certain cancers, the need for further
    myometrium. As most of the women with adenomyosis will surgery, early ovarian failure and menopause, depression, and
    end up undergoing hysterectomy which have long term other outcomes [3].So preventing the disease in its early stage
    complication in quality of life, therefore a better will help us in avoiding such strategies which have long term
    understanding regarding the etiopathogensis including the consequences. The prevalence of Adenomyosis among
    associated risk factors will help us in prevention and hysterectomy patients is highly variable from as low as 8.8%
    control of Adenomyosis. So this case control study was up to 56.6%.On TVS around 20.9% prevalence of
    carried out to find out the risk factors of Adenomyosis. adenomyosis was reported by Upson et all among
    Methodology: A case control study with an sample size of symptomatic gynaecological patients attending
    60,30 cases and 30 control. Results: There was no statistical Gynaecological clinic in United Kingdom[4] In India one of the
    association between age, parity, History of abortion, studies reported 16% prevalence of Adenomyosis among
    previous surgical history and smoking with adenomyosis. patients undergoing hysterectomy in a Tertiary Care Hospital
    Conclusion: Our study showed no association of the of kerela[5].Some of the already known risk factors of
    commonly known risk factors of Adenomyosis. Adenomyosis like older Age(4th or 5th decade of life),
    Multiparity, History of Prior Uterine surgery, Smoking,
    Keywords:- Adenomyosis, Risk Factor, Case Control. Depression and Tamoxifen treatment[6] but there is lack of
    research giving higher evidence of association of such risk
    I. INTRODUCTION factors with Adenomyosis, therefore this study was carried out
    to evaluate the risk factors of Adenomyosis among women
    According to ICD-10 classification Adenomyosis is attending Gynecological OPD in a tertiary care Hospital.
    classified under Non Inflammatory disorders of Genital Tract
    with code N80, specifically N80.0[1].It is an endometriosis of II. METHODOLOGY
    the uterus as it is the aberrant location of the endometrium
    inside the uterine Myometrium. Historically it was first Study Design: Case Control Study
    referred as adenomyoma by German pathologist Carl von
    Rokitansky in the year 1860. One of the most appropriate Sample Size: A purposive sample size of 60 participants were
    definition of Adenomyosis was given by Bird in 1972 as included in the study 30 cases & 30 Controls, Cases and
    “Adenomyosis may be defined as the benign invasion of control were selected from patients and screened by TVS and
    endometrium into the myometrium, producing a diffusely inducted consecutively till the sample size of 60 was attained.
    enlarged uterus which microscopically exhibits ectopic non-
    neoplastic, endometrial glands and stroma surrounded by the Study Period: 6 months May to October 2022.
    hypertrophic and hyperplastic myometrium[2] Few years back
    Adenomyosis was some sort of surgical diagnosis given after Study Area: OPD at O&G Department, Gauhati Medical
    the Histopathological examination, but with modern imaging College
    technique the spectrum of diagnostic tool has increased and
    improved. Now non invasive techniques like Trans Vaginal Cases: Patients at Gynaecology OPD of GMC who were
    Sonography(TVS) and MRI are more sensitive than before in advised a Trans vaginal USG (TVS) for further evaluation of
    diagnosing Adenomyosis. As one of the most effective their disease. Selection of cases were done from those
    treatments of Adenomyosis is Hysterectomy so a better screened patients who had any one of the following findings
    understanding of the etiopathogenesis of the disease may help on TVS.1) Indistinct endo-myometrial junction; (2)
    us in avoiding such operation. A better understanding asymmetry of the anterior and posterior myometrium; (3)

    IJISRT22NOV538 www.ijisrt.com 120


    Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
    myometrial striations; (4) myometrial cysts and fibrosis (5)
    heterogeneous myometrial echotexture (6)enlarged globular A total 60 participants were analyzed, 30 cases & 30
    uterus . controls. Mean Age of all the 60 participants was 37.7(±9.03)
    years and Mean parity was 2(±1.5) years (table 1).The mean
    Exclusion: Who did not give their consent for the study. age of both Cases and controls was similar, most of them in
    their 3rd decade of life. There were no variation in the
    Control: OPD patients who after TVS did not show the distribution of Religion, almost half of the population belongs
    features of Adenomyosis were selected as control. to Hindu and remaining half were Muslim, no patients were
    from other religions. Around 15% of the patients were
    Study Variables: Age, Marital status, Parity, Abortion, Illiterate i.e. they could not read and write when one standard
    Previous Surgical History, presenting Symptoms. Data were paragraph was shown and dictated to them.
    collected in pre tested predesigned Profoma and later on
    compiled in MS excel sheet for Analysis. A p value of ≤0.05 On statistical analysis none of the factors showed a
    was taken to be significant and Graph Pad Instat was used for significant association with Adenomyosis (Table 2).The
    statistical calculation. For continuous values T test was done patients who gave a positive history of previous uterine
    and for Qualitative value evaluation Chi square and Fisher’s surgery almost more than 90% of them gave their Surgical
    Exact test was done. History as Caesarian Section. There was no significant
    association of Adenomyosis with smoking & aborti0n.The
    Ethical clearance was taken from the Institutional Ethics various chief complaints of both the study groups were
    Committee Dysmennorhea, Abnormal Uterine Bleeding, Pain Abdomen,
    etc.
    III. RESULTS

    Table 1: Baseline Characteristics Of the cases & Controls


    Characteristics Cases (%) Control (%) Total(n=60)
    Mean Age(in years) 36.9±10.3 36.1±9.4 37.7(±9.03).
    Religion
    Hindu 16(53.5) 13(43.5) 29
    Muslim 14(46.5) 17(56.5) 31
    Se status
    Below poverty line 18(60) 23(76.5) 41
    Above poverty line 12(40) 7(33.5) 19
    Education status
    Illiterate 6(20) 3(10) 9
    Literate 24(80) 27(90) 51
    Total 30 30 60

    Table 2: Showing association of the probable risk factors of Adenomyosis.


    Characteristics Cases (%) Control (%) Statistical Test
    Mean Age(in years) 36.9±10.3 36.1±9.4 On t test P >0.05
    Mean Parity 1.73±1.1 2.1±1.8 On t test P >0.05
    History of Uterine Surgery
    Yes 19(63.5) 14(46.5) X2=1.07,P>0.05
    No 11(36.5) 16(53.5) OR=1.9(0.07-5.5)
    Abortion History
    Yes 12(40) 9(30) X2=0.65,P>0.05
    No 18(60) 21(70) OR=1.5(0.53-4.5)
    Smoking History
    Yes 2(6.5) 0(0) On Fisher’s Exact test, P>0.05,0R=5.35(0.24-
    No 28(93.5) 30(100) 116.4)
    Total 30(100%) 30(100%)

    IV. DISCUSSION presence of Endometrial hyperplasia which was significantly


    associated with an Odds ratio of 3(1.2-8.3) [7] .The association
    In our study there was no association of any the factors of age with adenomyosis may be due to their study population
    which were evaluated, one study reported a association of which was Hysterectomy patients which was often done on
    older age with Adenomyosis[6] but similar to our finding older age group. Shrestha A et all in a cross sectional study
    Bergholt et all also reported that there was no association found a significant association (p<0.05) of adenomyosis when
    adenomyosis with age, parity, indication of hysterectomy, pain comparing between Nullipara and Multiparous women also
    related symptoms or number of myometrial samples except there was a significant association with smoking history of

    IJISRT22NOV538 www.ijisrt.com 121


    Volume 7, Issue 11, November – 2022 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
    [8]
    more than 10 years with an Odds Ratio of 3.6 but in our study [9]. Garcia LE, Morris S, Isaacson K. Adenomyosis: Risk
    there was no association between smoking and adenomyosis Factors and Diagnosis. Journal of Minimally Invasive
    which may be due to low prevalence of smoking in this part of Gynecology. November 2011;18(6), S17-S18.
    India and only two cases gave the history of smoking that was [10]. Parazzini, F.; Vercellini, P.; Panazza, S.; Chatenoud, L.;
    also for less number of years. Garcia et all in her retrospective Oldani, S.; Crosignani, P.G. Risk Factors for
    evaluation of 428 patients who underwent hysterectomy found Adenomyosis. Hum. Reprod.1997,12, 1275–1279.
    significant association between Parity and Previous history of
    Dilation & curettage with adenomyosis, but similar to our
    findings there was no association with Age and Smoking
    status[9] .In contrast to our study finding one more study found
    a significant association of Adenomyosis with parity and
    History of abortion in a cross sectional study of 707 patients
    undergoing hysterectomy in Italy by Parazzini et all [10]
    .Therefore there was high disparity of study findings in all
    those literature which further demands more research with
    bigger sample size preferably a population based prospective
    study.

    V. CONCLUSION

    Finally the findings of our study showed that there was


    no association of factors like Age, Parity, history of abortion
    & smoking with adenomyosis.

    Conflict of Interest: No

    REFERENCES

    [1]. World Health Organization. (2004). ICD-10 :


    international statistical classification of diseases and
    related health problems : tenth revision, 2nd ed. World
    Health Organization.
    [2]. Benagiano G, Brosens I. History of adenomyosis. Best
    Pract Res Clin Obstet Gynaecol 2006; 20: 449–463
    [3]. Madueke-Laveaux OS, Elsharoud A, Al-Hendy A. What
    We Know about the Long-Term Risks of Hysterectomy
    for Benign Indication-A Systematic Review. J Clin Med.
    2021 Nov 16;10(22):5335. doi: 10.3390/jcm10225335.
    PMID: 34830617; PMCID: PMC8622061
    [4]. Upson K, Missmer SA. Epidemiology of Adenomyosis.
    Semin Reprod Med. 2020 May;38(2-03):89-107. doi:
    10.1055/s-0040-1718920. Epub 2020 Oct 26. PMID:
    33105509; PMCID: PMC7927213.
    [5]. Gopinath L, Vaidya R. Prevalence of adenomyosis and
    associated gynaecological pathologies in hysterectomy
    samples: a retrospective study. Int J Res Med Sci
    2021;9:2606-9.
    [6]. Taran FA, Stewart EA, Brucker S. Adenomyosis:
    Epidemiology, Risk Factors, Clinical Phenotype and
    Surgical and Interventional Alternatives to
    Hysterectomy. Geburtshilfe Frauenheilkd. 2013
    Sep;73(9):924-931. doi: 10.1055/s-0033-1350840.
    PMID: 24771944; PMCID: PMC3859152
    [7]. T. Bergholt, L. Eriksen, N. Berendt, M. Jacobsen, J.B.
    Hertz, Prevalence and risk factors of adenomyosis at
    hysterectomy, Human Reproduction, Volume 16, Issue
    11, November 2001, Pages 2418–2421,
    https://doi.org/10.1093/humrep/16.11.2418
    [8]. Shrestha A. Risk factors for adenomyosis. J Nepal Health
    Res Counc. 2012 Sep;10(22):229-33. PMID: 23281457.

    IJISRT22NOV538 www.ijisrt.com 122

    You might also like