Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot.
Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman's quality of life.
What Are the Symptoms of Adenomyosis?
While some women diagnosed with adenomyosis have no symptoms, the disease can cause:
- Heavy, prolonged menstrual bleeding
- Severe menstrual cramps
- Abdominal pressure and bloating
Who Gets Adenomyosis?
Adenomyosis is a common condition. It is most often diagnosed in middle-aged women and women who have had children. Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis.
Though the cause of adenomyosis isn't known, studies have suggested that various hormones -- including estrogen, progesterone, prolactin, and follicle stimulating hormone -- may trigger the condition.
Until recently, the only definitive way to diagnose adenomyosis was to perform a hysterectomy and examine the uterine tissue under a microscope. However, imaging technology has made it possible for doctors to recognize adenomyosis without surgery. Using MRI or transvaginal ultrasound, doctors can see characteristics of the disease in the uterus.
If a doctor suspects adenomyosis, the first step is a physical exam. A pelvic exam may reveal an enlarged and tender uterus. An ultrasound can allow a doctor to see the uterus, its lining, and its muscular wall. Though ultrasound cannot definitively diagnose adenomyosis, it can help to rule out other conditions with similar symptoms.
Another technique sometimes used to help evaluate the symptoms associated with adenomyosis is sonohysterography. In sonohysterography, saline solution is injected through a tiny tube into the uterus as an ultrasound is given.
MRI -- magnetic resonance imaging -- can be used to confirm a diagnosis of adenomyosis in women with abnormal uterine bleeding.
Because the symptoms are so similar, adenomyosis is often misdiagnosed as uterine fibroids. However, the two conditions are not the same. While fibroids are benign tumors growing in or on the uterine wall, adenomyosis is less of a defined mass of cells within the uterine wall. An accurate diagnosis is key in choosing the right treatment.
How Is Adenomyosis Treated?
Treatment for adenomyosis depends in part on your symptoms, their severity, and whether you have completed childbearing. Mild symptoms may be treated with over- the-counter pain medications and the use of a heating pad to ease cramps.
Anti-inflammatory medications. Your doctor 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 your period and continued through the first few of days of your period.
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.
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 blood supply cut off, the adenomyosis shrinks.
Endometrial ablation. This minimally invasive procedure destroys the lining of the uterus. Endometrial ablation has been found to be effective in relieving symptoms in some patients when adenomyosis hasn't penetrated deeply into the muscle wall of the uterus.
Does Adenomyosis Cause Infertility?
Because many women who have adenomyosis also have endometriosis, it is difficult to tell precisely what role adenomyosis may play in fertility problems. However, some studies have shown that adenomyosis may contribute to infertility.
Can Adenomyosis Be Cured?
The only definitive cure for adenomyosis is a hysterectomy, or the removal of the uterus. This is often the treatment of choice for women with significant symptoms.