What is Adenomyosis?
Adenomyosis is a medical condition that is characterised by the movement or encroachment of the endometrial tissue that lines the uterus into the muscles of the uterus, causing the uterine walls to become thicker and leading to menstrual problems.
Risk Factors of Adenomyosis
Some of the risk factors associated with adenomyosis include:
- History of multiple Pregnancies
- Aged 40-50 years- although the condition can also affect younger women including teens.
- Prior uterine surgery, or injury to the uterus from childbirth
- Endometriosis
Causes of Adenomyosis
Doctors are unsure as to what causes adenomyosis. However, the condition has been associated with increased levels of estrogen in women. Some of the other theories about the causes of adenomyosis include:
- Invasive tissue growth due to an invasion of endometrial cells from the lining of the uterus into the uterine muscle
- Presence of stem cells in the uterine muscle wall
- Uterine inflammation due to childbirth
- Developmental origin, such as when the uterus is first formed in the foetus
Symptoms of Adenomyosis
Some of the common symptoms associated with adenomyosis include:
- Heavy menstrual bleeding
- Menstrual cramps / painful periods
- Spotting between menstrual periods
- Prolonged menstrual cycles
- Pain or discomfort in the abdominal area
- Dyspareunia (painful sexual intercourse)
- Blood clots during menstrual bleeding
- Iron deficiency due to heavy periods, which can make you feel tired/ have low energy or dizzy
- Bloating or pressure in your pelvis/abdomen
- Low back pain
Diagnosis of Adenomyosis
To arrive at an accurate diagnosis, your doctor will first review your medical history and symptoms. Many women with adenomyosis will likely have a swollen or tender uterus during a pelvic exam. To confirm the diagnosis, your doctor may also order further tests, such as:
- Magnetic resonance imaging (MRI): An MRI scan is ordered to obtain high-resolution images to visualize the inner muscles of the uterus.
- Ultrasound: An ultrasound can assist in diagnosing the condition.
- Endometrial biopsy: A small sample of the endometrial tissue in the uterus is taken for testing under a microscope to rule out other causes with similar symptoms.
Adenomyosis can be hard to diagnose because there are no agreed tests to confirm the condition. It cannot be diagnosed from bleed tests or tissue samples (biopsies).
A certain diagnosis of adenomyosis is usually only confirmed if the uterus has been removed and checked in the pathology lab (hysterectomy)
How can adenomyosis affect fertility?
It makes it harder for:
- Sperm to fertilise an egg
- Embryos to implant into the lining of the uterus
- Embryos to delvelop
Treatment for Adenomyosis
Some of the treatment options employed to treat adenomyosis include:
- Hormonal medications such as progestin intrauterine devices (eg Mirena) , contraceptive pills, progesterone only pills, or Depo-Provera injection can help.
- Anti-inflammatory medications such as ibuprofen can help in alleviating pain and discomfort.
- Endometrial ablation is an outpatient procedure that involves techniques to destroy or remove the lining of the uterine cavity (endometrium) causing symptoms.
- Uterine artery embolization is a procedure that involves the placement of a tube in a major artery in the groin and injecting small particles into the sections affected by adenomyosis to mitigate symptoms.
- MRI-guided focused ultrasound surgery (MRgFUS) involves using precisely focused high-intensity waves to generate heat and destroy the affected tissue to relieve symptoms.
- Hysterectomy is considered a major surgical intervention and is the only decisive treatment for adenomyosis that involves total removal of the uterus. This surgery is only considered for those not wanting to become pregnant in the future.
In general, if a patient wants to conserve their fertility surgical options are best avoided.
Other adjunctive therapies to consider include:
- Pelvic Physiotherapy
- Mindfulness, psychological therapy or counseling
- Acupuncture and Yoga
