Understanding Adenomyosis
Adenomyosis is a benign uterine condition characterized by the presence of endometrial tissue (glands and stroma) growing within the muscular wall of the uterus (myometrium), causing the uterus to enlarge and leading to symptoms including heavy menstrual bleeding, painful periods, and pelvic pain.
What is Adenomyosis?
Adenomyosis occurs when the inner lining of the uterus (endometrium) breaks through and grows into the myometrium (the muscular wall of the uterus). Unlike normal endometrial tissue that sheds during menstruation, these displaced endometrial cells remain trapped in the muscle wall and:
- Respond to hormonal changes during your menstrual cycle, thickening, breaking down, and bleeding just like the lining of your uterus 1
- Cause the surrounding muscle to thicken, resulting in an enlarged uterus 2
- Create areas of inflammation and scarring within the uterine wall 1
Common Symptoms
Adenomyosis can cause several uncomfortable symptoms, though some women may be asymptomatic:
- Heavy or prolonged menstrual bleeding (menorrhagia) 3, 1
- Severe menstrual cramps (dysmenorrhea) that may worsen over time 1, 4
- Chronic pelvic pain or pressure 5, 4
- Pain during sexual intercourse (dyspareunia) 4, 6
- Infertility or pregnancy complications in some cases 1, 5
Who Gets Adenomyosis?
Adenomyosis most commonly affects:
- Women in their 40s and 50s (perimenopausal years) 2
- Women who have had children (multiparous) 2
- Women with other uterine conditions like endometriosis, uterine fibroids, or endometrial polyps 2, 4
How is Adenomyosis Diagnosed?
Historically, adenomyosis was only diagnosed after hysterectomy, but modern imaging techniques now allow for non-invasive diagnosis:
- Transvaginal ultrasound (TVUS) can identify characteristic features of adenomyosis 1, 4
- Magnetic Resonance Imaging (MRI) provides more detailed imaging and is considered the most accurate non-invasive diagnostic tool 1, 4
- Clinical symptoms and physical examination findings may suggest adenomyosis but are not specific enough for definitive diagnosis 1
Treatment Options
Treatment depends on symptom severity, desire for future pregnancy, and other factors:
Medical Management
- Hormonal treatments such as progestin IUDs have shown significant improvement in pain and bleeding in women with adenomyosis 3
- Combined oral contraceptives can help reduce painful and heavy menstrual bleeding 3
- GnRH antagonists are effective for heavy menstrual bleeding even with concomitant adenomyosis 3
Uterine-Preserving Procedures
- Uterine Artery Embolization (UAE) has shown promising results for women who desire to keep their uterus 3
Definitive Treatment
- Hysterectomy remains the only definitive treatment that completely resolves all symptoms 2, 6
- Should be considered when other treatments fail and fertility preservation is not desired 3
Important Considerations
- Adenomyosis often coexists with other conditions like fibroids or endometriosis, which may complicate diagnosis and treatment 1, 4
- Pregnancy is possible after UAE for adenomyosis, but comprehensive data on fertility outcomes is limited 3
- Surgical treatments other than hysterectomy may be complex and should be performed by experienced surgeons 6
- The condition may affect quality of life significantly through pain, heavy bleeding, and potential fertility issues 5, 4
When to Seek Medical Attention
You should consult your healthcare provider if you experience:
- Menstrual bleeding that is heavy enough to disrupt your daily activities 3
- Severe menstrual pain that doesn't respond to over-the-counter pain medications 1
- Increasing pelvic pain or pressure between periods 4
- Difficulty becoming pregnant 1, 5
Understanding adenomyosis and its treatment options can help you make informed decisions about managing this condition and improving your quality of life.