Is adenomyosis a chronic inflammatory condition?

From the Guidelines

Adenomyosis is a chronic inflammatory condition where the endometrial tissue grows into the muscular wall of the uterus, leading to symptoms such as severe menstrual cramps, heavy or prolonged menstrual bleeding, pelvic pain, and sometimes infertility. Although the provided evidence primarily discusses endometriosis, a related condition, it highlights the inflammatory nature of endometrial-like tissue outside the uterus 1. Adenomyosis, similarly, involves the growth of endometrial tissue into the uterine muscle, causing an inflammatory response within the uterus. This inflammation is estrogen-dependent and typically affects women during their reproductive years, often improving after menopause when estrogen levels decline.

Key Characteristics of Adenomyosis

• Estrogen-dependent condition
• Involves growth of endometrial tissue into the uterine muscle
• Leads to chronic inflammation and symptoms like pelvic pain and heavy bleeding
• Often affects women during their reproductive years

Treatment Options

• Pain medications like NSAIDs (ibuprofen, naproxen)
• Hormonal therapies such as birth control pills, progesterone-containing IUDs, or GnRH agonists to suppress estrogen production
• Surgical options including endometrial ablation, uterine artery embolization, or hysterectomy for severe cases unresponsive to medical management

The chronic inflammation associated with adenomyosis can lead to structural changes in the uterus over time, causing it to become enlarged and tender. It's also associated with other health issues, such as hypercholesterolemia, hypertension, and increased cardiovascular disease risk, as seen in conditions with chronic inflammation like endometriosis 1. Given the potential for significant morbidity and impact on quality of life, early diagnosis and appropriate management of adenomyosis are crucial.

From the Research

Definition and Characteristics of Adenomyosis

• Adenomyosis is a common gynecologic disease characterized by invasion of endometrial glands and stroma within the myometrium 2.
• It can result in abnormal uterine bleeding, pelvic pain, and infertility 2, 3.
• Adenomyosis is distinct from endometriosis, but the two conditions often occur simultaneously 3.

Diagnosis of Adenomyosis

• Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging 3.
• The use of pelvic imaging has demonstrated the existence of different forms of adenomyosis, notably allowing distinction between lesions of the external myometrium and those of the internal myometrium 2.

Treatment and Management of Adenomyosis

• Treatment of adenomyosis typically starts with hormonal menstrual suppression 3.
• Levonorgestrel-releasing intrauterine systems have shown some effectiveness in resolving abnormal uterine bleeding and reducing uterine volume 4, 3.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control pain symptoms, and other medical treatments such as progestins, oral contraceptives, and gonadotropin-releasing hormone analogues are also used off-label to control pain symptoms and abnormal uterine bleeding 5, 4.

Adenomyosis as a Chronic Inflammatory Condition

• The pathogenetic mechanisms of adenomyosis include sex steroid hormones aberrations, impaired apoptosis, and increased inflammation 4.
• The use of anti-inflammatory treatments such as NSAIDs and progestins suggests that adenomyosis has an inflammatory component 5, 4.
• However, there is limited evidence to suggest that adenomyosis is a chronic inflammatory condition in the same way as endometriosis, and more research is needed to fully understand the relationship between adenomyosis and inflammation 6.