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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
  • Prior uterine surgery

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
  • Spotting between menstrual periods
  • Prolonged menstrual cycles
  • Pain or discomfort in the abdominal area
  • Dyspareunia (painful sexual intercourse)
  • Blood clots during menstrual bleeding

Diagnosis of Adenomyosis

To arrive at an accurate diagnosis, your doctor will first review your medical history and perform a thorough pelvic and physical exam. Many women with adenomyosis will likely have a swollen or tender uterus during the 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 as well as rule out the possibility of tumours in the uterus.
  • 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.

Treatment for Adenomyosis

Some of the treatment options employed to treat adenomyosis include:

  • Hormonal medications such as progestin intrauterine devices, contraceptive pills, or Depo-Provera injection can help mitigate symptoms.
  • 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.
The University of Western AustraliaST John of God Health CareGlengarry Private Hospital