Specialities

Adenomyosis

What is it?

With adenomyosis, the tissue that lines the uterus (endometrium) grows within the uterus' muscular outer walls. This is most likely to happen from the age of 30-50.

Adenomyosis isn't the same as endometriosis, a condition in which the uterine lining becomes implanted outside the uterus. Although the cause of adenomyosis remains unknown, the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, there are medical treatments that can help, but hysterectomy is the only final cure.

Although adenomyosis can be quite painful, the condition usually carries no risk.

Signs and symptoms

Among some women, adenomyosis is "silent" — causing no signs or symptoms — or only mildly uncomfortable. But other women with adenomyosis may experience:

• Excessive menstrual bleeding; heavy or prolonged

• Severe cramping pain during menstruation (dysmenorrhea)

• Menstrual cramps that last throughout your period and worsen as you get older

• Pain during intercourse

• Bleeding between periods

• Passing blood clots during your period

Your uterus may increase to double or triple its normal size. Although you might not know if your uterus is enlarged, you may notice that your lower abdomen seems bigger or feels tender.

How is adenomyosis diagnosed?

Your doctor may suspect adenomyosis based on:

* Signs and symptoms
* A pelvic examination, which reveals an enlarged uterus that's painful to touch
* Ultrasound imaging of the uterus
* Magnetic resonance imaging (MRI) of the uterus
 

The only way to be certain about a diagnosis of adenomyosis happens after the uterus has been removed (hysterectomy) and biopsies have been studied.

Many women have other uterine diseases that can be confused with the signs and symptoms of adenomyosis, making adenomyosis more difficult to diagnose. Such conditions include fibroid tumors (leiomyomas), uterine cells growing outside the uterus (endometriosis) and growths in the uterine lining (endometrial polyps). You may be evaluated first for other conditions that cause abnormal uterine bleeding. Your doctor may diagnose adenomyosis only after he or she determines there are no other causes for your signs and symptoms.

What are the problems that adenomyosis causes?

• Pain may be debilitating and interfere with your day to day activities

• Bleeding may lead to anaemia

• Pain during sexual intercourse may disrupt your sexual life

• Unlike endometriosis, adenomyosis doesn't usually affect fertility.

Treatment

Adenomyosis usually resolves after menopause, so treatment may depend on how close you are to that stage of life. If you're nearing menopause, your doctor may have you try anti-inflammatory medications to control the pain. By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take it during your period, you can reduce menstrual blood flow in addition to relieving pain.

Hormone therapy is another treatment option that may be helpful. Controlling your menstrual cycle through combined estrogen-progestin oral contraceptives may lessen the heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device containing progestin [Mirena], or a continuous-use birth control pill, often leads to amenorrhea — the absence of your menstrual periods — which may provide relief.

If your pain is severe and menopause is years away, your doctor may suggest removing your uterus (hysterectomy). Removing your ovaries isn't necessary to control adenomyosis.