What is Adenomyosis, symptoms and treatments?

Adenomyosis is a condition where the cells of the uterine lining grow into the muscular wall of the uterus. It is similar to endometriosis and can cause similar symptoms or no symptoms at all. This condition most often occurs late in childbearing years and typically disappears after menopause when estrogen levels decrease. Most women receive a diagnosis within the ages of 32–38 years.

During a person’s menstrual cycle, these “trapped” cells undergo stimulation by the hormones of the menstrual cycle, similar to the mucous membrane lining of the uterus. This can make menstrual cramps and bleeding more severe than usual.

In most cases adenomyosis may cause heavy or prolonged menstrual bleeding, severe cramping, pain during intercourse or blood clots that pass during a period. Certain medications can help relieve pain or lessen heavy bleeding, but in severe cases removal of the uterus (hysterectomy) would be the only option to cure this condition.

Symptoms and causes:

The symptoms of adenomyosis vary throughout the menstrual cycle because of rising and falling levels of estrogen, which affect the shedding of the uterus lining.

Around one third of women do not experience any symptoms at all, while for others, symptoms can disrupt daily life.

Possible symptoms of adenomyosis include:

  • heavy menstrual bleeding
  • very painful periods
  • pain during sex
  • bleeding between periods
  • worsening uterine cramps
  • an enlarged and tender uterus
  • general pain in the pelvic area
  • a feeling that there is pressure on the bladder and rectum
  • pain while having a bowel movement.

Doctors are not sure what the exact causes of adenomyosis is, but several theories include:

  • Fetal development: Adenomyosis may be present in a person before birth when the uterus first forms in a fetus.
  • Inflammation: that occurs in a person’s uterus during uterine surgery could also increase the risk of adenomyosis.
  • Invasive tissue: Injury to the uterus, such as during a cesarean delivery or other surgery, may also cause adenomyosis. This is because the endometrial-like tissue grows into the muscle.

What is the difference between adenomyois and endometriosis:

Adenomyosis and endometriosis are very similar, but there are a few differences such as in adenomyosis, cells lining the uterus grow into the uterus muscle,where as in endometriosis, these cells grow outside the uterus, sometimes on the ovaries and Fallopian tubes as well. These two conditions are equally widespread, though endometriosis occurs more often in women in their 30s and 40s, while more women aged 40- 50 years tend to develop adenomyosis. It is possible for a person to have both endometriosis and adenomyosis, although symptoms of both conditions typically subside after menopause.

Treatment and diagnosis:

Diagnosis begins with a consultation with a doctor. They will likely take a medical history and perform a physical and pelvic exam. A person will often feel tenderness in her uterus during the pelvic exam. If a doctor thinks that the uterus feels slightly enlarged and they suspect adenomyosis, they may consider other tests,which include an:

  • Ultrasound: This allows the doctor to examine pockets of the uterus lining tissue in the muscle of the uterus.
  • MRI: This is a common way for the doctor to see the inner uterus muscle.
  • Endometrial biopsy: Sometimes, the doctor will want to take a small sample of the endometrial tissue in the uterus for testing. While it will not help diagnose adenomyosis, it will rule out other causes of a person’s symptoms.

These tests may not provide a definite diagnosis, although adenomyosis can definitely be diagnosed once a person has had a hysterectomy as well as when a pathologist (specialized doctor) examines the uterus under the microscope.

Treatment is not necessary if a person has no symptoms, is not trying to get pregnant, or is nearing menopause, which is when most people find relief from their symptoms. However without treatment, adenomyosis may remain the same or worsen. 

Treatment options available include:

  • Anti-inflammatory medications: Medications, such as ibuprofen, can reduce pain and discomfort.
  • Medications: Oral contraceptive pills, progestin intrauterine devices, or injections (Depo-Provera) can help ease symptoms. In addition, doctors can prescribe gonadotropin-releasing hormone agonists or antagonists, but usually only in the short term, as they can induce false or temporary menopause. In rare cases, healthcare professionals may prescribe them for the long term if a person does not respond to other treatments.
  • Uterine artery embolization: This involves placing a tube in a major artery in the groin and injecting small particles into the affected area. This stops the blood supply from reaching the area, shrinking the adenomyosis and reducing symptoms.
  • Hysterectomy: The only definitive treatment for adenomyosis is the complete removal of the uterus. It may be an unsuitable option for a person who still wants to become pregnant unless all therapies have failed and they wish to prioritize pain relief over pregnancy.

Adenomyosis is not a life threatening condition on its own, although the condition will go away once a person reaches menopause it can cause severe discomfort and lead to complications before then. It is always advised to consult your doctor if they suspect any concerns regarding these conditions.

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