Adenomyosis is a condition in which endometrial tissue invades the muscular wall of the uterus, resulting in the enlargement of the uterus. This displaced endometrium acts normally during the menstrual cycle, thickens, breaks down, and bleeds just like the normal endometrial tissue. Pain is experienced in the pelvic region during the menstrual cycle and ranges from dull and cramping to sharp and stabbing in character.
Symptoms of adenomyosis
- Menstrual cramps
- Enlarged uterus
- Dyspareunia, pain during sex
- Heavy, prolonged bleeding during periods
- Clots in blood
- Abdominal pressure and tenderness
- Pelvic pain
Causes of adenomyosis
The exact cause of adenomyosis is unknown. However, several theories suggest:
- Invasive growth: Normal endometrial lining invades the muscular wall of the uterus and cells begin to grow there.
- C-section scar: A C-section scar in the uterus can also promote direct, invasive growth of the endometrium into the myometrium.
- Origin of development: Some suggest that endometrial tissue is present in the muscular wall of the uterus by birth, and during puberty, these cells begin to grow rapidly and result in adenomyosis.
- Inflammatory cause: After childbirth, the uterine lining undergoes inflammation, this may break the normal boundary between both cell lines and allow the endometrium to grow into the muscular layer.
- Stem cell origin: According to a recent theory, bone marrow stem cells might encroach the uterine muscular wall, resulting in adenomyosis.
- Excess estrogen levels: Excess of body circulating estrogen levels are responsible for the promotion and growth of already developed adenomyosis.
Risk factors for the development of adenomyosis are:
- A C-section scar or any other uterine surgery
- Previous pregnancy and childbirth
- Age between 35 and 50 years
- Uterine fibroids
- Pelvic inflammatory disease
- Abnormal hormone levels – high estrogen
Complications of adenomyosis
Major complications include:
- Chronic pain syndrome
- Anemia due to excessive blood loss
- Difficulty in getting pregnant
- Painful sex
Difference between adenomyosis and endometriosis
- Adenomyosis and endometriosis, both involve endometrium and are painful conditions. The main difference between both is the location of abnormal growth of endometrial tissue.
- In adenomyosis, endometrial tissue invades and encroaches into the myometrium. While endometriosis is the growth of endometrium outside the uterine cavity, most commonly occupying ovaries, fallopian tubes, peritoneum, and pelvic cavity.
Adenomyosis is diagnosed based on the history of the patient’s symptoms and some tests, that are:
- A pelvic examination can help identify a bulky and larger uterus that is tender to touch.
- Ultrasound can help identify the thickening of the muscular lining of the uterus, ruling out suspicion of any tumor mass.
- MRI and CT scan can help in the definitive diagnosis.
- Endometrial biopsy is only done in patients who undergo a hysterectomy to look for any signs of cancerous growth.
Management of adenomyosis
Females who have asymptomatic adenomyosis, do not require any sort of treatment. However, women with severe forms of this condition, require some sort of treatment that is entirely dependent upon the extent of the disease. Moreover, all of the treatment methods are employed to reduce the severity of the condition and symptoms.
- Anti-inflammatory medications are prescribed to be taken, two to three days before the onset of the period and continuing throughout the period to reduce the menstrual cramps and heavy bleeding.
- Hormonal oral contraceptive pills can also control the excessive rise in estrogen levels.
- Intrauterine devices like; levonorgestrel intrauterine system, is also helpful in females who do not want conception for up to 5 years.
- Iron supplements are given to females with anemia due to excessive blood loss.
- Mood enhancers like serotonin can also be given to females with mood disorders like depression and anxiety.
- Endometrial ablation: This procedure involves the removal or destruction of endometrial lining.
- Uterine artery embolization: A major artery that supplies to the uterus can be ligated. This results in progressive shrinkage of adenomyosis.
- MRI-guided focused ultrasound surgery (MRgFUS): This method includes using high-intensity waves to generate heat and cause the destruction of abnormal tissue.
- Hysterectomy is the only permanent cure and can only be done in severe cases and in females who do not plan to conceive in the future.
- A heating pad can reduce pain and inflammation.
- Yoga and stretching can help lower stress levels and discomfort due to symptoms.
- Turmeric mixed with milk reduces inflammation.
- Vitex – chaste berry is known to decrease estrogen levels and is a great food to take in adenomyosis.
When to consult a doctor?
If you have been diagnosed with adenomyosis, you should look for the following symptoms and consult the doctor as soon as possible:
- Extremely heavy and prolonged periods
- Menstrual cramps stronger than ever before
- Nausea and vomiting
- Redness of the overlying skin and tenderness
- Trouble getting pregnant.
Can adenomyosis affect pregnancy?
Yes, adenomyosis makes it difficult for the zygote to implant in the uterus and thus, causing trouble to conceive. However, infertility treatments can help with successful pregnancy.
Can you leave adenomyosis untreated?
Most of the time, adenomyosis is only mild in severity and can be left untreated. However, females with severe symptoms require treatment to prevent the development of any sort of complications such as anemia due to blood loss.
Does adenomyosis get worse over time?
In patients with high estrogen levels, adenomyosis can get worse, as estrogen promotes the growth of the endometrium.