Adenomyosis is a condition where the cells that usually line the uterus grow into the muscle wall of the uterus. The condition is thought to be related to endometriosis, which is characterized by the growth of these cells outside the uterus.
Causes of adenomyosis
It is not entirely understood what causes adenomyosis, but there are a few theories.
Uterine incisions, which may be the result of surgeries such as a cesarean section (C-section), may promote the invasion of cells lining the uterus into the muscle wall of the uterus and facilitate their growth at this new site.
Some experts think that inflammation may be a trigger for the development of adenomyosis. Vaginal injury or inflammation related to childbirth can damage the normal boundary of cells that line the uterus.
Adenomyosis commonly occurs in women who are in their 40s or 50s, which supports the theory that childbirth is a risk factor for the condition. It may, however, also be diagnosed in young women who have never given birth.
Symptoms of adenomyosis
The most common symptoms of adenomyosis are heavy and prolonged menstrual bleeding and pain during menstruation, which can be severe. The loss of large amounts of blood can cause anemia (a low red blood cell count), which is associated with increased tiredness and dizziness.
Women who have adenomyosis can become pregnant, but the condition is associated with an increased risk of miscarriage and premature birth.
Diagnosis of adenomyosis
Adenomyosis is difficult to diagnose, and numbers about its incidence range from 10 percent to 35 percent.
It is not possible to diagnose adenomyosis based only on symptoms, because they are not specific to the condition and other uterine diseases can have similar symptoms.
The collection and analysis of a small piece of uterine tissue or an endometrial biopsy can be used to exclude other conditions that may cause excessive bleeding. A biopsy might also detect adenomyosis, but the chances are small because the cells are often restricted to a particular site of the uterus and can easily be missed.
Adenomyosis can be diagnosed by ultrasound. The test should be performed by a gynecologist who is specialized in ultrasound.
MRI (magnetic resonance imaging) is another imaging technique that can help diagnose adenomyosis. It generates pictures and allows the physician to have a closer look at the uterus and muscles surrounding it.
In most cases, adenomyosis is only definitely diagnosed after a hysterectomy or the removal of the uterus. It is then possible to analyze the uterus in much more detail than otherwise possible.
Hysterectomy is also used to treat adenomyosis. Before performing a hysterectomy, the consequences must be carefully considered as it is an irreversible operation, and means women won’t be able to become pregnant anymore. Like all major surgeries, hysterectomy also has a risk of complications.
Treatment of adenomyosis
Options to manage adenomyosis include medications, nonsurgical interventions, and surgery.
Medical treatment
Anti-inflammatory medications, such as ibuprofen, can help to reduce the pain caused by adenomyosis.
Hormonal medications are also widely used to relieve the symptoms of adenomyosis. The oral contraceptive pill is known to reduce the excessive bleeding and pain in some women, but not in others.
Progesterone-releasing intrauterine devices, such as Mirena, have been reported to reduce pain and menstrual bleeding effectively. Another option is the use of GnRH agonists, artificial hormones that prevent ovulation and suppress menstruation. However, they should only be used temporarily and are not a permanent solution.
Non-surgical interventions
Ultrasound waves that are guided by MRI can be used to locally increase the temperature of tissues and kill the cells forming adenomyosis. Another approach is to block the blood supply to adenomyosis with the help of small particles. This technique is known as uterine artery occlusion.
Surgical treatment
Laparoscopy or keyhole surgery allows the removal of focal adenomyosis (adenomyoma).
Hysterectomy or partial hysterectomy is a very effective method to end adenomyosis-related symptoms, but it is only performed in severe cases where other treatment options have been unsuccessful.
Since the symptoms of adenomyosis stop when a women enters menopause, the time left to this stage of a woman’s life is also a factor that influences she should undergo a hysterectomy.
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