Adenomyosis vs Endometriosis: Differences Based on Causes, Symptoms, Treatments, Diagnosis

Adenomyosis and endometriosis are both conditions that affect the endometrial tissue that lines the uterus. The endometrium is the tissue present inside the uterus that the body sheds off during the monthly menstrual periods. Sometimes, this endometrium lining spreads to places inside the body where it should not be present. This can lead to different medical conditions known as endometriosis and adenomyosis. Both endometriosis and adenomyosis share some symptoms, affect different parts of the body, and may also require different treatments. It is also possible to have both of these conditions at the same time, and doctors do not know the exact cause of these disorders. Read on to find out more about adenomyosis vs. endometriosis.

Adenomyosis and endometriosis are two different types of disorders that affect the endometrial tissue lining the uterus. Both of these conditions develop in different ways and also have some different symptoms.

In adenomyosis, the endometrial cells start to grow within the wall of the uterus. These cells are, of course, misplaced in this location. If you have adenomyosis, as the uterus wall thickens, it may lead to pain and heavy bleeding. This condition is known to more commonly affect older women. Adenomyosis has recently been linked with infertility in women, as well. ⁽¹⁾

In endometriosis, the endometrial cells start to grow outside of the uterus. If you have endometriosis, the endometrial tissue can be commonly found on the ovaries and in the cavities of the pelvis. The growing of the endometrial cells outside the uterus also causes pain and may also lead to infertility. Endometriosis is most commonly observed in women of reproductive age and adolescents. It is possible to have both of these conditions at the same time. A study done in 2017 on 300 women who were diagnosed with adenomyosis between 2008 and 2016, found that 42.3 percent of these participants also had endometriosis. ⁽²⁾ Adenomyosis vs. Endometriosis: Difference in Location Differences are:

In adenomyosis, the lining of the endometrium starts growing deep inside the muscle wall of the uterus and starts to thicken it further. In adenomyosis, the endometrium tissue does not grow beyond the uterus itself. Due to this, the condition of adenomyosis is sometimes also referred to as internal endometriosis.

When you have endometriosis, on the other hand, the lining of the uterus starts to spread and grow outside of the uterus. This growth can also breach other organs that are nearby, including your fallopian tubes, the ovaries, and even the bladder. This makes it difficult for a woman to get pregnant.

Symptoms of both disorders, inclusive of pain, can be mild to severe. However, many women with endometriosis sometimes experience no signs. At the same time, it is also estimated that nearly one-third of all women who have adenomyosis do not experience any symptoms. ⁽³⁾ Some of the symptoms of these disorders also mimic those that are caused by disorders such as uterine fibroids or ovarian cysts, making it difficult to diagnose. Some of the general symptoms observed in adenomyosis and endometriosis include:

• Adenomyosis
• Dysmenorrhea (painful periods)
• Dyspareunia (pain during sexual intercourse)
• Chronic pelvic pain
• Abnormal bleeding or prolonged periods
• Enlarged uterus
• Infertility

The enlarged uterus in adenomyosis can further cause the following symptoms:

• Cause heavy and painful periods
• Put pressure on your rectum and bladder
• Change the way your uterine muscles contract or tighten
• Endometriosis
• Dysmenorrhea (painful periods)
• Dyspareunia (pain during sexual intercourse)
• Chronic pelvic pain
• Duschezia (pain during bowel movements)
• Dysuria (painful urination)
• Fatigue
• Nausea
• Diarrhea (especially during your periods)

The exact cause of both adenomyosis and endometriosis is not clearly known. However, researchers have identified some of the likely mechanisms and some risk factors that are responsible for causing these disorders. Some of these theories include:

• Adenomyosis and endometriosis may be caused due to tissue injury and repair (TIAR) after there has been some trauma to the uterus. Estrogen production is also believed to be involved in this process. ⁽⁴⁾
• Any injury to the endometrial tissue may activate the stem cells, causing them to grow outside of their usual location in endometriosis and adenomyosis. ⁽⁵⁾
• Menstrual blood that flows where it is not supposed to, such as through the fallopian tubes), may leave behind endometrial tissue in the pelvis or other areas.
• Genetic factors, especially in endometriosis, as it has been observed to run in families.
• Problems with the immune system that may cause a failure to regulate straying endometrial tissue in both disorders.
• The lymph system that may start carrying endometrial cells to other organs.
• Problems with the hormonal system of the body and estrogen that transform embryonic cells in the abdomen into endometrial cells.

Without any symptoms, your first diagnosis is likely to take place when your doctor is treating you for something else. If you are experiencing symptoms such as pelvic pain, then your doctor will take a medical history and also enquire more about your symptoms. A physical examination and other imaging tests will be done. To rule out some of the possible causes of pelvic pain, you might be prescribed a urine test, a PAP smear, a pregnancy test, or vaginal swabs.

• Adenomyosis is difficult to diagnose. There are noninvasive diagnostic tools such as MRI and sonograms available to diagnose adenomyosis.
• Since adenomyosis causes enlargement of the uterus, the doctor performs a physical exam to check whether your uterus is swollen or tender.
• A sonogram is typically done first, and an MRI may be required to confirm the diagnosis.
• In some cases, to get a more precise image, a sonohysterography may be prescribed. In this, a saline solution is injected into the uterus before performing a sonogram.

• A sonogram and an MRI are also ordered to diagnose endometriosis. The sonogram is typically performed with a wand-type scanner across the abdomen, or sometimes it is inserted into the vagina.
• Laparoscopic surgery might be performed to search for endometrial tissue outside of the uterus.
• There is a lot of research ongoing into more non-invasive methods of diagnosing endometriosis with the use of blood tests. However, no specific biomarker has been identified as of yet.

Treatment for both these disorders ranges from over-the-counter drugs to a hysterectomy. The treatment options vary depending on the location of the misplaced endometrial tissue.

If you only have mild symptoms, then your doctor is likely to recommend over-the-counter anti-inflammatory medications to be taken before and during your period. For controlling more severe symptoms, there are many other options, including: Hormones are used for controlling the increased estrogen levels that are responsible for the symptoms. These hormonal therapies can include:

• Oral contraceptive pills
• High dose progestins
• Danazol
• Levonorgestrel-releasing intrauterine device

MRI-guided focused ultrasound surgery that uses focused ultrasound energy that is delivered to deep tissue without causing any damage to the surrounding tissue. Hysterectomy – involves complete removal of the uterus to eliminate adenomyosis. This method is not considered to women who want to have children.

For mild endometriosis symptoms, over-the-counter anti-inflammatory drugs are prescribed. For more serious symptoms, the following options may be prescribed:

Hormone supplements may be given to help with:

• Pain
• Regulating your periods
• Reducing the growth of endometrial tissue

These medications are typically started with a low dose of oral contraceptives and then determining the treatment of seeing the results. Low-dose combined oral contraceptive pills are usually the first line of treatment for endometriosis. Some examples may include progestins and ethyl estradiol.

• The second tier treatment for endometriosis includes progestins, androgens (such as danazol), and gonadotropin-releasing hormone agonists (GnRH). These are known to decrease endometriosis pain.
• Conservative surgery can be used to remove endometriosis laparoscopically, while also keeping the uterus intact. This will help relieve the symptoms, but the endometriosis can still return.
• Laparoscopy can also be used with current or laser or heat treatments for removing endometriosis.
• Hysterectomy (complete removal of the uterus) and removal of the ovaries is typically considered as a last resort.

Both adenomyosis and endometriosis can be painful conditions. Both are progressive conditions, but there are effective treatments for these disorders, which ensures that the conditions do not become life-threatening. Early diagnosis of both and the right treatment can lead to a better outcome when it comes to pain and symptom relief. Adenomyosis and endometriosis make it difficult for a woman to conceive, and if you are facing infertility issues, you should consult your doctor about what the best treatment plan will be for you. References

1. Harada, T., Khine, Y.M., Kaponis, A., Nikellis, T., Decavalas, G. and Taniguchi, F., 2016. The impact of adenomyosis on women’s fertility. Obstetrical & gynecological survey, 71(9), p.557.
2. Antero, M.F., O’Sullivan, D., Mandavilli, S. and Mullins, J., 2017. High prevalence of endometriosis in patients with histologically proven adenomyosis. Fertility and Sterility, 107(3), p.e46.
3. Ferraz, Z., Nogueira-Martins, N. and Nogueira-Martins, F., 2017. Adenomyosis: Back to the future?. Facts, views & vision in ObGyn, 9(1), p.15.
4. Leyendecker, G., Wildt, L. and Mall, G., 2009. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Archives of gynecology and obstetrics, 280(4), pp.529-538.
5. Vannuccini, S., Tosti, C., Carmona, F., Huang, S.J., Chapron, C., Guo, S.W. and Petraglia, F., 2017. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reproductive biomedicine online, 35(5), pp.592-601.