Adenomyosis: Symptoms, Causes, Diagnosis & Treatment

Written By: Dr. Shiva Harikrishnan

A highly qualified and more than 30 years experienced obstetrics and gynaecology senior consultant, Dr.Shiva Harikrishnan is currently practicing at Medcare Women & Children Hospital.

Updated On:December 06, 2023

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What is Adenomyosis?

Endometrial tissue, which ordinarily lines the uterus, develops into the muscular uterine wall, causing adenomyosis. Each menstrual cycle, the dislocated tissue behaves normally, swelling, degrading, and bleeding. There may be an enlarged uterus and painful, lengthy periods.

Adenomyosis normally goes away after menopause, but doctors are unsure of what causes it. Hormonal therapies can aid women who experience significant pain from adenomyosis. Adenomyosis is treated by having the uterus removed (hysterectomy).

 Causes of Adenomyosis

Adenomyosis has an unknown cause. However, there are numerous theories, such as:

  • Invasive tissue development. According to some specialists, the muscle that makes up the uterine walls is invaded by endometrial cells from the uterus lining. Endometrial cells may directly invade the uterine wall as a result of uterine incisions produced during procedures like cesarean sections (C-sections).
  • Developmental basis. Some scientists think that as the uterus first develops in the fetus, endometrial tissue is deposited in the uterine muscle.
  • Childbirth-related uterine irritation. Adenomyosis and childbirth may be related, according to another view. An interruption in the usual boundary of the cells that line the uterus may result from postpartum uterine lining inflammation.
  • Stem cell basis. According to a recent notion, bone marrow stem cells could infect the uterine muscle and result in adenomyosis.

Symptoms of Adenomyosis

Adenomyosis can occasionally go undetected or just cause little discomfort. But adenomyosis can result in the following symptoms:

  • Heavy or persistent period bleeding
  • Severe cramps or acute, knife-like pelvic pain (dysmenorrhea) during your period
  • Persistent pelvic discomfort
  • Painful sexual activity (dyspareunia)

Also, your uterus may enlarge. Even though you might not be aware of the growth of your uterus, you might feel pressure or soreness in your lower abdomen.

When to see a doctor for Adenomyosis?

Make an appointment to visit your doctor if your period is causing severe cramps or heavy bleeding that lasts for an extended amount of time and keeps you from doing your normal activities.

Adenomyosis Risk Factors

Adenomyosis risk factors include:

  • Prior surgery, such as a C-section, the excision of fibroid(s), or dilatation and curettage (D&C)
  • Childbirth
  • Age

Most women in their 40s and 50s are affected by adenomyosis, an estrogen-dependent condition. These women's higher estrogen exposure than younger women may be the cause of their adenomyosis. However, younger women may also be more susceptible to the illness.

Adenomyosis Complications

You may develop chronic anemia, which results in exhaustion and other health issues, if you frequently experience prolonged, heavy bleeding during your periods.

Although not hazardous, adenomyosis-related pain and profuse bleeding can cause disruptions in your daily routine. If you're in discomfort or concerned that you could start bleeding, you might refrain from doing things you used to like.

Adenomyosis Diagnosis

Adenomyosis can have symptoms and signs that are similar to those of other uterine disorders, making it challenging to diagnose. These disorders include endometriosis, fibroid tumors, and growths in the uterine lining known as endometrial polyps. Fibroid tumors are also known as leiomyomas.

Only after ruling out other potential causes for your signs and symptoms will your doctor come to the conclusion that you have adenomyosis.

Adenomyosis may be suspected by your doctor based on

  • Your symptoms
  • An enlarged, painful uterus is discovered during a pelvic exam
  • Ultrasound to image the uterus
  • MRI of the uterus using magnetic resonance imaging

To be sure you don't have a more serious condition, your doctor may occasionally take an endometrial biopsy to obtain a sample of uterine tissue for testing. Your doctor can't confirm the presence of adenomyosis with an endometrial biopsy, though.

The only means to confirm adenomyosis is to inspect the uterus after hysterectomy, despite the fact that adenomyosis can be detected using pelvic imaging techniques, such as ultrasound and MRI.

 Adenomyosis Treatment

Treatment may vary depending on how near you are to menopause, as adenomyosis frequently disappears after that time in life.

The following are possible adenomyosis treatments:

  • Medicines that reduce inflammation. Your doctor may suggest anti-inflammatory drugs such as ibuprofen to manage the discomfort. You can lessen menstrual blood flow and lessen pain by starting an anti-inflammatory medication one to two days before the start of your period and taking it throughout your period.
  • Hormone-based medication. Hormone patches, vaginal rings, and estrogen-progestin birth control pills can all help with extreme bleeding and pain associated with adenomyosis. Amenorrhea, or the lack of menstrual cycles, is a typical adverse effect of progestin-only methods of birth control, such as an intrauterine device or continuous-use birth control pills.
  • Hysterectomy. If your discomfort is severe and no other treatments have worked, your doctor can suggest surgically removing your uterus. Without removing your ovaries, adenomyosis can be treated.

Adenomyosis Prevention

Given that there is no accurate consensus on the cause of adenomyosis, there are no proven methods to prevent this condition from happening.

References

Bergeron, C., Amant, F., & Ferenczy, A. (2006). Pathology and physiopathology of adenomyosis. Best practice & research Clinical obstetrics & gynaecology20(4), 511-521.

Ferenczy, A. (1998). Pathophysiology of adenomyosis. Human reproduction update4(4), 312-322.

Garcia, L., & Isaacson, K. (2011). Adenomyosis: Review of the literature. Journal of minimally invasive gynecology18(4), 428-437.

Parazzini, F., Vercellini, P., Panazza, S., Chatenoud, L., Oldani, S., & Crosignani, P. G. (1997). Risk factors for adenomyosis. Human reproduction (Oxford, England)12(6), 1275-1279.

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