What is Adenomyosis?
Adenomyosis is a condition where the endometrial tissue, which lines the uterus, starts to grow into the muscular wall of the uterus. This displaced endometrial tissue continues to thicken, break down and bleed, as it normally would in each menstrual cycle due to which there is enlargement of the uterus along with heavy and painful periods. Patients suffering from Adenomyosis commonly start experiencing symptoms after having children late in the childbearing years. The cause of adenomyosis is not known and this disease usually disappears after menopause. There are treatments which can help in relieving the symptoms of pain and discomfort; however, the only cure for Adenomyosis is hysterectomy.
Causes of Adenomyosis
The exact cause of adenomyosis is unknown. Some of the possible causes include:
- According to research, adenomyosis may start from inside the uterine muscle where the endometrial tissue develops when the uterus initially forms in the fetus.
- It is also believed that adenomyosis occurs as a result of direct invasion of the endometrial cells into the muscle, which form the walls of the uterus. Incisions to the uterus made during certain operations, such as a cesarean section can promote or trigger the direct invasion of the endometrial cells into the uterine wall.
- According to the latest theory, adenomyosis can occur as a result of invasion of bone marrow stem cells into the uterine muscle.
- There also can be a relation between childbirth and adenomyosis where there is inflammation of the uterus after childbirth due to a break in the normal boundary of the cells lining the uterus.
Irrespective of the origin of adenomyosis, the increase in the growth of adenomyosis depends on the estrogen which is present in a woman's body. Decrease in the production of the estrogen, such as during menopause, leads to gradual resolving of adenomyosis.
Risk Factors of Adenomyosis
- Uterine surgeries, such as done for removal of fibroids or C-section.
- Middle aged women who are in their 40s to 50s. It could be related to increased exposure for a longer period of time than younger women. Previously adenomyosis was usually diagnosed during a hysterectomy.
- According to research, adenomyosis may be more common than is known and often goes undetected in younger women.
Signs & Symptoms of Adenomyosis
Adenomyosis doesn't always produce signs or symptoms and can be silent or mildly uncomfortable. Symptoms present in adenomyosis include:
- Menstrual bleeding which is heavy or prolonged.
- Patient experiences dysmenorrhea with severe cramping or sharp pain, which is knife like in intensity during menstruation.
- Cramping during menstrual periods, which are present throughout the period and exacerbate as the patient gets older.
- Dyspareunia, which is pain during intercourse.
- Presence of blood clots, which pass during the period.
- Enlargement of the uterus where the lower abdomen feels tender or gets bigger.
Investigations to Diagnose Adenomyosis
- Medical history & physical exam.
- Pelvic examination which reveals a tender and enlarged uterus.
- Ultrasound imaging and Magnetic Resonance Imaging (MRI) of the uterus.
- Biopsy of the endometrial tissue can also be done where a sample of the uterine tissue is taken and sent to the lab for testing. Endometrial biopsy is done to rule out other serious causes of abnormal uterine bleeding.
- A biopsy doesn't help in confirming the diagnosis of adenomyosis. Examination of uterus after hysterectomy is the only way to confirm the diagnosis of adenomyosis.
There are other diseases of the uterus, which also produce signs and symptoms similar to adenomyosis thus making the diagnosis of adenomyosis difficult. Some of the conditions, which have similar symptoms, include leiomyomas (fibroid tumors), endometriosis and endometrial polyps.
Treatment for Adenomyosis
As adenomyosis commonly resolves after menopause, treatment depends on the stage of life the patient is in. Treatment for adenomyosis comprises of:
- Anti-inflammatory medications, such as naproxen and ibuprofen may be tried if the patient suffering from Adenomyosis is nearing menopause. Anti-inflammatory medicines help in managing the pain. Anti-inflammatory medicines should be started two to three days before the menstrual period starts and should be taken throughout the period to help relieve pain and reduce menstrual blood flow.
- Hormonal medications, such as combination of estrogen and progestin birth control pills or hormone vaginal rings or patches, help in reducing the pain and heavy bleeding of adenomyosis. Contraceptives which are progestin-only such as birth control pills or intrauterine devices usually will lead to amenorrhea, which will provide relief from symptoms.
- Hysterectomy is the only cure for adenomyosis. If the patient is having severe pain and there are some years before menopause occurs then surgery for removing the uterus (hysterectomy) is recommended for controlling adenomyosis. Removal of ovaries is not required for controlling adenomyosis.
- There are some conservative measures, which the patient suffering from Adenomyosis can take to ease the pelvic pain and cramping, such as soaking in a warm bath and application of heating pad on the abdomen.