Adenomyosis occurs when the endometrial tissue that normally borders the uterus develops into the muscular wall of the uterus. During each menstrual cycle, the misplaced tissue continues to function normally, thickening, breaking down, and bleeding. An enlarged uterus and painful, heavy periods are possible outcomes.
Adenomyosis is unknown to doctors, however it normally resolves following menopause. Hormonal therapies can help ladies who are suffering from severe adenomyosis discomfort. Adenomyosis is cured by removing the uterus (hysterectomy).
Symptoms
Sometimes, adenomyosis causes no signs or symptoms or only mild discomfort. However, adenomyosis can cause:
- Heavy or prolonged menstrual bleeding
- Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
- Chronic pelvic pain
- Painful intercourse (dyspareunia)
Your uterus might get bigger. Although you might not know if your uterus is bigger, you may notice tenderness or pressure in your lower abdomen.
When to see a doctor
Make an appointment with your doctor if you have prolonged, heavy bleeding or severe cramps during your periods that interferes with your normal activities.
Causes
The cause of adenomyosis isn't known. There have been many theories, including:
- Invasive tissue growth. Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) might promote the direct invasion of the endometrial cells into the wall of the uterus.
- Developmental origins. Other experts suspect that endometrial tissue is deposited in the uterine muscle when the uterus is first formed in the fetus.
- Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
- Stem cell origins. A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.
Regardless of how adenomyosis develops, its growth depends on the body's circulating estrogen.
Risk factors
Risk factors for adenomyosis include:
- Prior uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C)
- Childbirth
- Middle age
Most cases of adenomyosis — which depends on estrogen — are found in women in their 40s and 50s. Adenomyosis in these women could relate to longer exposure to estrogen compared with that of younger women. However, current research suggests that the condition might also be common in younger women.
Complications
Chronic anaemia, which causes exhaustion and other health concerns, can occur if you experience prolonged, heavy bleeding during your periods on a regular basis.
Although not hazardous, the pain and heavy bleeding associated with adenomyosis can interfere with your daily activities. You might avoid activities you used to enjoy because you're in discomfort or afraid you'll start bleeding.
Diagnosis
Some other uterine conditions can cause signs and symptoms similar to those of adenomyosis, making adenomyosis difficult to diagnose. These conditions include fibroid tumors (leiomyomas), uterine cells growing outside the uterus (endometriosis) and growths in the uterine lining (endometrial polyps).
Your doctor might conclude that you have adenomyosis only after ruling out other possible causes for your signs and symptoms.
Your doctor may suspect adenomyosis based on:
- Signs and symptoms
- A pelvic exam that reveals an enlarged, tender uterus
- Ultrasound imaging of the uterus
- Magnetic resonance imaging (MRI) of the uterus
In some instances, your doctor might collect a sample of uterine tissue for testing (endometrial biopsy) to make sure you don't have a more serious condition. But an endometrial biopsy won't help your doctor confirm a diagnosis of adenomyosis.
Pelvic imaging such as ultrasound and MRI can detect signs of adenomyosis, but the only way to confirm it is to examine the uterus after hysterectomy.
Treatment
Adenomyosis often goes away after menopause, so treatment might depend on how close you are to that stage of life.
Treatment options for adenomyosis include:
- Eva™. The combination of Graphene Heating and TENS Technology is useful to relieve the pain.
- Anti-inflammatory drugs. Your doctor might recommend anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medicine one to two days before your period begins and taking it during your period, you can reduce menstrual blood flow and help relieve pain.
- Hormone medications. Combined estrogen-progestin birth control pills or hormone-containing patches or vaginal rings might lessen heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device, or continuous-use birth control pills often cause amenorrhea — the absence of your menstrual periods — which might provide some relief.
- Hysterectomy. If your pain is severe and no other treatments have worked, your doctor might suggest surgery to remove your uterus. Removing your ovaries isn't necessary to control adenomyosis.
