Adenomyosis is a condition in which the tissue lining the uterus, the endometrium, grows through the myometrium (the wall of the uterus). This endometrial tissue will continue to act as though it was within the uterus during each menstrual cycle and result in thickening, breakdown and bleeding. Despite being a benign or non-cancerous condition, adenomyosis can affect a woman’s quality of life due to symptoms of pain and bleeding. Heavy menstrual bleeding associated with adenomyosis can not only affect a woman’s lifestyle but can also in some cases lead to the development of anemia. The pain that is generally associated with the condition can also cause emotional disturbances such as depression, anxiety, etc.
While the causes of adenomyosis are not currently known or understood, there are several theories around how one develops the condition. These theories include that of invasive tissue growth, fetal developmental origins and inflammation secondary to childbirth. Additionally there are recent discussions that stems cell origin can be a cause due to bone marrow stem cell invasion into the muscle of the uterus. There have been studies discussing that hormones such as estrogen, progesterone, prolactin and follicle stimulating hormone may be responsible for prompting the development of adenomyosis. The condition generally resolves after menopause when the levels of estrogen in the body decrease.
Even though the cause of adenomyosis is unknown as discussed above, certain women may be at a higher risk of developing the condition as opposed to others and include those with a previous surgery on the uterus such as a c-section or procedure to remove fibroids. Additionally, other risk factors include childbirth and being of middle age (40’s and 50’s).
Some women only experience mild symptoms of adenomyosis and in fact there may be no symptoms at all however most commonly women experience the following symptoms leading to a diagnosis of the condition:
- Long or heavy menses
- Severe menstrual cramping referred to as dysmenorrhea
- Menstrual cramping lasting your entire menses which actually worsens with age
- Painful intercourse
- Passage of blood clots with menses
- Uterine enlargement, abdominal enlargement and/or tenderness
- Pressure/Bloating in the abdomen
In order to diagnose adenomyosis your healthcare provider will generally complete a physical exam and order additional tests to determine its presence or the presence of another condition causing the symptoms. Many times, suspicion of the condition is raised based on symptoms, presence of an enlarged and/or tender uterus on examination, and findings found on ultrasound and magnetic resonance imaging (MRI).
Another test used at times is a sonohysterography which is used in conjunction with an ultrasound. Unfortunately, the only way to confirm the diagnosis is by hysterectomy (removal of the uterus). In order to rule out other conditions causing the symptoms, your healthcare provider may obtain an endometrial biopsy to rule out cancer.
Treatment for adenomyosis may include several options including the use of non-steroidal anti-inflammatory medications such as ibuprofen or hormonal medication such as combination birth control pills with the hormones estrogen and progestin, hormonal vaginal rings or patches. At times, it may be recommended to stop your menses for a period of time to treat the symptoms and methods such as continuous-use birth control or use of a progestin only intrauterine device (IUD) may be utilized.
Additional medication include the use of aromatase inhibitors and GnRH analogs. Procedures such as uterine artery embolization and endometrial ablation may at times be considered and in certain cases such as severe pain and when menopause is not near, a hysterectomy may be recommended.
If you think that you are experiencing symptoms associated with adenomyosis, discuss your concerns with your healthcare provider.