What Is Adenomyosis?
Adenomyosis is a condition that involves the movement, or encroachment,
of the tissue that lines the uterus (endometrial tissue) into the muscles of
the uterus. This causes thickening of the uterine walls. It may lead to heavy
or longer-than-usual menstrual bleeding as well as pain during your menstrual
cycle or intercourse.
The exact cause of this condition is unknown. However, it’s more
common in women with increased levels of estrogen. Adenomyosis usually
disappears after menopause (12 months after a woman’s final menstrual period).
This is when estrogen levels decline.
There are several theories about what causes adenomyosis. These
- extra tissues in the uterine wall present before
birth that grow during adulthood
- invasive growth of abnormal tissues (called
adenomyoma) from endometrial cells pushing themselves into the uterine muscle — this may be due to an incision made
in the uterus during surgery (such as during a cesarean delivery)
- stem cells in the uterine muscle wall
- uterine inflammation that occurs after
childbirth — this may break the
usual boundaries of the cells that line the uterus
Risk Factors for Adenomyosis
The exact cause of adenomyosis is unknown. However, there are
factors that put women at greater risk for the condition. These include:
- being in your 40s or 50s (before menopause)
- having children
- having had uterine surgery, such as a cesarean delivery
or surgery to remove fibroids
Symptoms of Adenomyosis
Symptoms of this condition can be mild
to severe. Some women may not experience any signs at all. The most common
- prolonged menstrual cramps
- spotting between periods
- heavy menstrual bleeding
- longer menstrual cycles than normal
- blood clots during menstrual bleeding
- pain during sex
- tenderness in the abdominal area
A complete medical evaluation can help
to determine the best course of treatment. Your doctor will first want to
determine if your uterus is swollen through a physical exam. Many women with
adenomyosis will have a uterus that is double or triple the normal size.
Other tests may also be used. An
ultrasound can help your doctor to diagnose the condition, while also ruling
out the possibility of tumors on the uterus. An ultrasound uses sound waves to
produce moving images of your internal organs — in this case, the uterus. For
this procedure, your doctor will place a liquid conducting gel on your abdomen.
Then, they’ll place a small handheld probe over the area. The probe will
produce moving images on the screen to help your doctor see inside the uterus.
Your doctor may order an MRI scan to
get a clearer image of the uterus if they are unable to make a diagnosis using
an ultrasound. An MRI uses a magnet and radio waves to produce pictures of your
internal organs. This procedure involves lying very still on a metal table that
will slide into the scanning machine. If you’re scheduled to have an MRI, be
sure to tell your doctor if there is any chance you’re pregnant. Also be sure
to tell your doctor if you have any metal parts or electrical devices inside
your body, such as a pacemaker, piercings, or metal shrapnel from a gun injury.
Treatment Options for Adenomyosis
Women with mild forms of this condition
may not require medical treatment. Your doctor may recommend treatment options
if your symptoms interfere with your daily activities.
Treatments aimed at reducing the symptoms of adenomyosis
include the following:
An example is ibuprofen. These
medications can help to reduce blood flow during your period while also
relieving severe cramps. The Mayo
Clinic recommends starting anti-inflammatory
medication two to three days before the start of your period and continuing to
take it during your period.
These include oral contraceptives
(birth control pills), progestin-only contraceptives (oral, injection, or an intrauterine
device), and GnRH-analogs such as Lupron (leuprolide). Hormonal treatments can help to
control increased estrogen levels that may be contributing to your symptoms. Intrauterine
devices, such as Mirena, can last up to five years.
This involves techniques to remove or
destroy the endometrium (lining of the uterine cavity). It’s an outpatient
procedure with a short recovery time. However, this procedure may not work for
everyone since adenomyosis often invades the muscle more deeply.
Uterine Artery Embolization
This is a procedure that prevents certain arteries from supplying blood to
the affected area. With the blood supply cutoff, the adenomyosis shrinks. Uterine
artery embolization is typically used to treat another condition called uterine
fibroids. The procedure is performed in a hospital. It usually involves staying
overnight afterward. Since it’s minimally invasive, it avoids scar formation in
MRI-Guided Focused Ultrasound Surgery (MRgFUS)
MRgFUS uses precisely focused high-intensity
waves to create heat and destroy the targeted tissue. The heat is monitored
using MRI images in real time. Studies
have shown this procedure to be successful in providing relief of symptoms.
However, more studies are needed.
The only way to
completely cure this condition is to have a hysterectomy. This involves
complete surgical removal of the uterus. It’s considered a major surgical
intervention and is only used in severe cases and in women who don’t plan to
have any more children. Your ovaries don’t affect adenomyosis and may be left
in your body.
Potential Complications with Adenomyosis
Adenomyosis isn’t necessarily harmful.
However, the symptoms can negatively affect your lifestyle. Some people have excessive
bleeding and pelvic pain that may prevent them from enjoying normal activities
such as sexual intercourse.
Women with adenomyosis are at an
increased risk of anemia. Anemia is a condition often caused by an iron
deficiency. Without enough iron, the body cannot make enough red blood cells to
carry oxygen to the body’s tissues. This can cause fatigue, dizziness, and
moodiness. The blood loss associated with adenomyosis can reduce iron levels in
the body and lead to anemia.
The condition has also been linked with
anxiety, depression, and irritability.
Adenomyosis is not life-threatening. Many
treatments are available to help alleviate your symptoms. A hysterectomy is the
only treatment that can eliminate them altogether. However, the condition often
goes away on its own after menopause.
Adenomyosis is not the same as endometriosis.
This condition occurs when the endometrial tissues become implanted outside of
the uterus. Women with adenomyosis may also have or develop endometriosis.