What is Adenomyosis?

Adenomyosis is a condition of the female reproductive system that develops when the endometrial tissue, which lines the uterus, grows into the muscular wall of the uterus. The condition causes the uterine wall to become thicker and distorts the blood vessels, which may lead to heavy bleeding, painful periods, painful sex, prolonged periods, or infertility.

Adenomyosis is not the same as endometriosis, but people with adenomyosis may have endometriosis concurrently, or go on to develop endometriosis. The difference between adenomyosis and endometriosis is where the endometrial tissue grows. With endometriosis, the tissue grows outside of the uterus, sometimes in the ovaries, fallopian tubes, pelvic side walls, or bowels. With adenomyosis, the tissue grows into the muscle of the uterus.

Some people who develop adenomyosis may experience no symptoms at all, while other people may have symptoms that range from mild to more severe. Because adenomyosis depends on estrogen, the condition typically resolves after menopause or if a hysterectomy is performed.

Symptoms

There are several symptoms of adenomyosis, which can vary in levels of severity. Some people may experience no symptoms at all.  Symptoms include:

• Painful menstrual cramping
• Heavy menstrual bleeding
• Prolonged periods
• Chronic pelvic pain
• Pain during intercourse
• Infertility issues
• Enlarged uterus

Causes

There is no known cause for adenomyosis. The condition is more common in women who have had children. Although much more research is needed, some have suggested that the condition may be correlated with the following:

• Invasive tissue growth. This happens when endometrial cells from the lining of the uterus break through the muscles of the uterine wall. Some experts believe uterine incisions, such as a C-section, may cause the endometrial cells to break through the wall of the uterus.
• Developmental origins. Some experts theorize that endometrial cells may be deposited in the uterine muscle when the uterus is first formed in the fetus.
• Uterine inflammation due to childbirth. Some experts believe that inflammation of the uterine lining after childbirth may cause a weakening of the normal boundary of cells lining the uterus.
• Stem cell origins. This theory believes that bone marrow stem cells possibly invade the uterine muscle, causing adenomyosis.

Diagnosis

Your healthcare provider will diagnose adenomyosis according to your symptoms and by using one or more specific tests or diagnostic tools. These include:

• Pelvic exam. A doctor will conduct a pelvic exam to determine if the uterus is enlarged, softer, or if it is more painful when palpated.
• Ultrasound. The transvaginal ultrasound uses soundwaves to produce images of the pelvic organs. Additionally, it can detect any thickening of the uterine muscle, which signals a possibility of adenomyosis.
• Imaging tests. These tests have the capability of detecting any enlargement or thickening of uterine muscles and pelvic organs.
• Biopsy. The only time this procedure would be administered is after a hysterectomy because the tissue grows within the uterine wall.

Risk Factors

Risk factors for adenomyosis include:

• Middle aged
• Childbirth
• Prior uterine surgery, such as a C-section, dilatation and curettage (D&C), or fibroid removal

Complications

People who experience prolonged and heavy periods on a consistent basis may develop chronic anemia, which can cause fatigue or other health problems. Additionally, the intensity of pain and discomfort that some people experience with adenomyosis, may disrupt normal life activities.

Treatment

There are several forms of treatment for adenomyosis. People who have little to no symptoms may not need specific treatment. However, those who experience more severe symptoms, treatments include:

• Anti-inflammatory medications. Medications that help to reduce inflammation (i.e., ibuprofen, Advil, or Motrin IB) will help control pain associated with adenomyosis. Medication taken two days before the start of your period and during your period will help to reduce pain and blood flow.
• Hormone medications. Some hormone treatments or medications can lessen the pain or bleeding from your period. Other hormone medications may cause you to not have a period, which typically alleviates any symptoms from adenomyosis.
• Hysterectomy. If no treatment has been successful at alleviating severe symptoms, your doctor may recommend a hysterectomy to remove your uterus.