From the Guidelines
Adenomyosis is a condition where the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus, causing painful, heavy periods and other symptoms. This condition is characterized by the displacement of endometrial tissue into the uterine muscle, leading to an enlarged uterus and symptoms such as severe menstrual cramps, prolonged menstrual bleeding, pelvic pain, pain during intercourse, and pressure on the bladder or rectum 1. The normal boundary between the endometrium and myometrium becomes disrupted, allowing endometrial cells to migrate into the muscle layer, resulting in adenomyosis.
Symptoms and Treatment
Symptoms of adenomyosis typically include:
- Severe menstrual cramps
- Prolonged menstrual bleeding
- Pelvic pain
- Pain during intercourse
- Pressure on the bladder or rectum Treatment options vary based on symptom severity and may include:
- Pain medications like NSAIDs
- Hormonal treatments such as birth control pills or IUDs containing progestin
- Surgical procedures like endometrial ablation or hysterectomy in severe cases According to a recent study, progestin IUDs have been shown to reduce painful and heavy menstrual bleeding in women with adenomyosis, and are clinically favored due to their local mechanism of action and long duration of action 1.
Diagnosis and Management
Adenomyosis is often diagnosed using imaging techniques such as MRI, and can be managed with a range of treatments, including medical and surgical options. The American College of Radiology recommends uterine artery embolization (UAE) as a treatment option for women with adenomyosis who fail conservative measures and desire uterus-preserving therapy 1.
Quality of Life and Mortality
The goal of treatment for adenomyosis is to improve quality of life and reduce symptoms, while also minimizing the risk of morbidity and mortality. According to a recent meta-analysis, UAE has been shown to improve symptom scores and quality of life in women with adenomyosis, with a low rate of hysterectomy for persistent symptoms 1. The most effective treatment for adenomyosis should be determined on a case-by-case basis, taking into account the individual woman's symptoms, medical history, and preferences.
From the Research
Definition and Overview of Adenomyosis
- Adenomyosis is a heterogenous gynecologic condition characterized by the infiltration of the myometrium by ectopic endometrial islets 2, 3, 4.
- It is a benign uterine condition that can affect women at various ages with different symptoms 5.
- The condition often causes menorrhagia and dysmenorrhea, although some women with adenomyosis are asymptomatic 2, 4, 6.
Clinical Presentations and Diagnosis
- The most common presentation of adenomyosis is heavy menstrual bleeding and dysmenorrhea 2, 6.
- Patients can also be asymptomatic, and the condition is often diagnosed in women between 40 to 50 years of age 6.
- Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging 2, 6.
- Noninvasive imaging can be used to help guide the differential diagnosis, and 3-dimensional transvaginal ultrasound is superior to 2-dimensional transvaginal ultrasound for the diagnosis of adenomyosis 2.
Treatment Options
- Treatment of adenomyosis typically starts with hormonal menstrual suppression, and levonorgestrel-releasing intrauterine systems have shown some effectiveness 5, 6.
- Medical treatments, including nonhormonal and hormonal treatments, are effective in improving symptoms such as pain, abnormal uterine bleeding, and infertility 5, 3.
- Hysterectomy is the only definitive management option for patients with adenomyosis, but medical treatments remain the best options for women with a future desire of pregnancy 2, 3, 6.