What is adenomyosis?

Adenomyosis is a distinct medical condition affecting the female reproductive organs, primarily the endometrial tissue. Normally, endometrial tissue lines the inner portion of the uterus. With adenomyosis, however, the endometrial tissue migrates into the outer muscular walls of the uterus. Once referred to endometriosis interna, adenomyosis differs distinctly from endometriosis - a reproductive disorder in which endometrial tissue becomes implanted in areas outside of the womb - because it affects the muscular walls within the uterus. Both conditions are structural gynecological disorders, as opposed to hormonal imbalances, and links between the two have been found in some cases.

Although adenomyosis is considered a benign medical condition (not life-threatening), it can have a significant, comprehensive impact on the lives of those afflicted with the disorder. From painful and uncomfortable symptoms to potential adverse fertility consequences, repercussions created by adenomyosis can certainly affect an individual's physical and emotional well-being. New developments in medical science and technology have allowed physicians to effectively treat adenomyosis using methods other than hysterectomies alone.

What causes adenomyosis and who does it affect?

Adenomyosis is a relatively common condition most typically diagnosed in middle-aged women and in women late in child-bearing years after they have had children. Some studies have suggested causal links to uterine trauma (which causes disruptions between the endometrium and muscular walls of the uterus), particularly in women who have had prior uterine surgery, C-sections, tubal ligation, or pregnancy. Medical research has also suggested links to various hormones, including estrogen, progesterone, and prolactin, which may account for the condition predominately affecting pre-menopausal women between the ages of 35 and 50, as menopause decreases the production of such hormones.

While research, studies, and many speculative theories surround adenomyosis, there is no definitively known cause for the disorder. Experts' theories suggest causes that include:

  • Invasive tissue growth - This is a direct invasion of endometrial cells from the surface of the uterus into the muscular tissue that forms the uterine walls. Uterine trauma or incisions, such as those made during C-sections, may promote invasive tissue growth into the walls of the uterus.
  • Uterine inflammation from childbirth - Inflammation of uterine walls after childbirth may potentially disrupt the normal boundary of cells that line the uterus, thereby promoting the growth of endometrial tissues into the muscular walls of the uterus.
  • Formation of the uterus - Adenomyosis may originate within the muscles of the uterus when endometrial tissue is deposited there during the formation/development of the uterus as a fetus.
  • Stem cells - New studies suggest that bone marrow stem cells may enter into the uterine muscle, thereby causing adenomyosis.

These theories, of course, are speculative. Regardless of the cause, treatments are available. Additionally, the progression of the condition may be influenced by the amount of estrogen present. As estrogen production decreases, such as during menopause, adenomyosis may eventually subside.

What are the symptoms of adenomyosis?

In some cases, women with adenomyosis may experience no apparent signs of the condition or only mild symptoms. Others, however, may have severe, debilitating symptoms. Common symptoms include:

  • Heavy and/or prolonged menstruation
  • Painful, sharp menstruation, cramping, and pelvic pain
  • Pain during intercourse
  • Bleeding between menstruation
  • Abdominal pressure and bloating
  • Passing of blood clots during menstruation

Depending on the severity of these symptoms, one's well-being can be significantly compromised. Discomfort and other symptoms can also impact daily life, causing collateral repercussions that have an adverse impact on emotions and personal relationships. Although studies are still not clear, adenomyosis may also affect fertility. If you experience signs and symptoms of adenomyosis, especially if they are severe and/or heavily impact your quality of life, then you should seek medical attention to explore treatment options.

Diagnosing Adenomyosis

In many cases, the diagnosis of adenomyosis comes as an unsuspecting clinical discovery during procedures affecting the uterus for other reasons. Today, more effective diagnostic tools, including X-ray imaging, ultrasound, and MRIs, have been used to detect the condition, its scope and extent, and to differentiate it from other similar conditions, including uterine fibroids.

Given the common symptoms, numerous potential causes, and general lack of medical information regarding the condition, adenomyosis is frequently undiagnosed or misdiagnosed. Erroneous diagnoses can lead to ineffective or unnecessary treatment, including hysterectomy surgery. Second opinions are strongly encouraged.

Treatment for Adenomyosis

Treatment options always depend on the symptoms involved, their severity, and the age of a patient. As adenomyosis is not a life-threatening condition and because it usually goes away after menopause, treatment options generally focus on managing symptoms and promoting a better quality of life for patients. Mild symptoms can often be effectively managed with the use of non-steroidal anti-inflammatory drugs (NSAIDs), which are taken prior to and during menstruation. Hormone therapy, including birth control pills and intrauterine devices (IUDs), may also be used to control serious symptoms such as heavy or painful periods. Other minimally invasive techniques, including uterine artery embolization and endometrial ablation, can be used to minimize and relieve symptoms.

Hysterectomy Surgery and Adenomyosis

A hysterectomy, or the removal of the uterus, is a treatment options doctors may consider only when symptoms are severe and cannot be managed until menopause. While a hysterectomy is a serious approach to treating adenomyosis, it can effectively eliminate symptoms. Given the high potential for misdiagnoses of adenomyosis and the fact that other treatment options are available, the general consensus is that the need for a hysterectomy should be assessed on a case-by-case basis.

If you have been diagnosed with adenomyosis, have consulted other medical professionals, and still wish to learn more about the condition and your available treatment options, is a resource you can trust to provide you with access to the information and specialized medical advice you need. Feel free to contact us for more information.