Adenomyosis – causes, symptoms and treatment

What is adenomyosis?

Adenomyosis is when tissue similar to the lining of the uterus (endometrium) starts to grow into the muscle wall of the uterus (myometrium). It causes the uterus to thicken and enlarge — sometimes, up to double or triple its usual size. Doctors are still not sure why it is caused, but it is usually resolved after menopause.

Symptoms of adenomyosis

Apart from the times when adenomyosis doesn’t cause any or just mild symptoms, in all the rest cases it causes:

1. Heavy or prolonged menstrual cycles
2. Heavy cramping (dysmenorrhea) and pelvic pain
3. Painful sexual intercourse
4. Bloating or fullness in the belly (adenomyosis belly)
5. Infertility

Who is more likely to be affected by adenomyosis?

Women

who:

1. Are between the age of 40 and 50.
2. Have given birth at least once.
3. Have had prior uterine surgeries such as uterine fibroid removal or dilation and curettage (D&C).
4. Have endometriosis.

Adenomyosis vs. endometriosis

In endometriosis, endometrial-type tissue grows outside the uterus. In adenomyosis, abnormal tissue grows into the uterine muscle. Although they are different conditions they can both cause pelvic pain, unusual menstrual bleeding, and heavy periods.

Because the two conditions share some common symptoms, it can be difficult for doctors to diagnose in time one over the other. 

They also don’t know the exact prevalence of either of the two diseases. This is because people with endometriosis for example often do not receive a diagnosis for many years, and surgery is the only way to definitively diagnose it. This means that the actual number of people with may be much higher than current estimates.

Most estimates suggest that 10–15% of reproductive-age women have the condition. Among those with pelvic pain, the prevalence may be as high as 70%.

Similar issues of under-reporting and underdiagnosis exist for adenomyosis too.

Diagnosis of adenomyosis

• Pelvic exam: During this type of exam, the doctor may notice that the uterus has gotten larger, softer, or painful to the touch.
• Ultrasound: A transvaginal ultrasound uses sound waves to produce images of the pelvic organs. These images can sometimes show a thickening of the uterine wall.
• Imaging scans: Magnetic resonance imaging (MRI) scans can show uterine enlargement and thickening of certain areas of the uterus.

Adenomyosis treatment

Treatment depends on the severity of the symptoms and if the woman has already given birth. Mild symptoms are usually treated with medication.

1. Anti-inflammatory medications. Doctors may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild pain associated with adenomyosis. NSAIDs are usually started one to two days before the beginning of a menstrual cycle and continue through the first few days of the period.
2. Hormone therapy. Symptoms such as heavy or painful periods can be controlled with hormonal therapies such as a levonorgestrel-releasing IUD (which is inserted into the uterus), aromatase inhibitors, and GnRH analogs.
3. Uterine artery embolization. In this minimally invasive procedure, which is commonly used to help shrink fibroids, tiny particles are used to block the blood vessels that provide blood flow to the adenomyosis. The particles are guided through a tiny tube inserted by the radiologist into the patient’s femoral artery. With the blood supply cut off, the adenomyosis shrinks. 
4. Endometrial ablation. This minimally invasive procedure destroys the lining of the uterus and is effective in relieving symptoms in some patients when adenomyosis hasn’t penetrated deeply into the muscle wall of the uterus.

Adenomyosis and fertility

There are cases of women who have simultaneously adenomyosis and endometriosis. That being said doctors find it difficult to understand how adenomyosis on its own may cause infertility struggles, but studies suggest that it may contribute to infertility. 

According to recent studies, adenomyosis negatively affects IVF, pregnancy, and live birth rates, as well as increases the risk of miscarriage. In addition, it enhances the risk of obstetric complications, such as premature birth and preterm rupture of the amniotic membranes. 

There is no specific treatment for patients with adenomyosis who want to preserve their fertility. Sometimes, combined treatment can be proposed, such as laparoscopy, GnRH treatment, and IVF.

When comparing pharmacological and surgical treatment, the latter appears to be more effective but some details are unclear, i.e., how long pregnancy should be delayed after treatment and whether hormone treatment after surgery improves fertility outcome. Despite many studies on the pathogenesis of fertility failure in adenomyosis, their results are not correlated with treatment. 

Not to be bothered with the scientific terms while reading the article, the most important thing to keep in mind, is the importance of finding the right doctor for you. A doctor who understands your wants and needs and will suggest the right actions. Although adenomyosis – and endometriosis too – may take a long to be diagnosed, that doesn’t mean that there is no hope for those who wish to conceive. Even with the tiniest of symptoms, you should feel comfortable to reach out to your doctor and ask for his/her help. 

MEDIPASS cooperates with 8 highly experienced fertility specialists who perform fertility treatments in some top-notch around the country. Having one of them as your doctor would be a privilege, and also having us by your side will surely make your fertility journey less lonely and stressful.