Adenomyosis is considered benign and not life threatening; however, the heavy bleeding and frequent pain associated with this condition can negatively impact a woman's quality of life. Women having symptoms of this condition should speak with a healthcare professional as soon as possible as the pain can worsen and even be debilitating. Timely treatment can maintain quality of life.
Definition & Facts
Adenomyosis is a common condition that often begins to affect a woman's health after the age of 35. This condition occurs when the endometrial tissue begins to grow into the muscle layers of the uterus. Typically, endometrial tissue lines the uterus, but when affected by adenomyosis, the endometrial tissue begins to implant itself into the uterine muscle. This results in the thickening of the uterus, which can spread throughout the uterine muscle, or women may develop an adenomyoma, which is a growth or mass inside the uterus.
Approximately 1 in 100 women will be affected by adenomyosis in their lifetime. Women who have had one or more children and are in their 30s and 40s have a higher risk for developing adenomyosis and infertility. This condition is rarely seen in women who have not carried their pregnancy to term.
Symptoms & Complaints
The affected tissue within the uterine muscle can be diffuse, localized, clustered or scattered. Typically, symptoms begin to occur in women between the ages of 40 and 50. The most common symptom associated with this condition is abnormal uterine bleeding.
This most often causes heavy periods or painful periods. Upon physical exam, the uterus is often noted to be enlarged, spongy to the touch and inadequately contracted. Women affected by this condition may have a uterus that is enlarged two or three times normal size. Other symptoms associated with adenomyosis include the following:
- Dysmenorrhea (painful menstrual cycles, pain can increase over time)
- Painful sexual intercourse
- Mid-cycle bleeding
- Menstrual bleeding that is clotting, heavy or long-term (bleeding can last up to 14 days and longer)
- Feeling of an enlarged uterus or the presence of a mass
- Abdominal pressure, abdominal distension, and abdominal tenderness
- Vaginal pressure (feels similar to the last stages of labor)
- Sudden stabbing pains across the abdomen during menstrual cycle
- Sharp internal pain upon sitting
- Pain that radiates down one or both of the legs/thighs
- Diarrhea or constipation
- Frequent urination
- Lower back pain
The exact cause of adenomyosis is still unknown at this time. However, research studies have previously suggested that various hormones including progesterone, estrogen, prolactin and follicle stimulating hormone may trigger this condition.
There are some theories as to what may cause this condition. The first is invasive foreign tissue growth. This would be the case in women who have had previous uterine surgery, as it is thought that the incisions made during the surgical procedure promoted the direct invasion of endometrial cells into the muscle layers of the uterus.
The second theory is uterine inflammation from childbirth, which suggests that the inflammation of the uterus after giving birth may break the boundary between the myometrium and endometrium, allowing endometrial cells into the myometrium.
Lastly, one theory suggests that abnormal uterine development may be a cause. This is thought to occur during uterine development in the female embryo, and it is thought that somehow the formation of endometrial cells are deposited into muscles of the uterus.
Diagnosis & Tests
Previously, the only way to definitively diagnose adenomyosis was by performing a hysterectomy and placing the uterine tissue under a microscope for examination. Now, advancements in imaging technology have made it possible for physicians to recognize this condition without performing surgery. Physicians are able to identify characteristics of this condition by using transvaginal ultrasound or an MRI. An MRI is useful in identifying adenomyosis in women who are experiencing abnormal uterine bleeding.
However, upon visiting a physician, the first step would be to perform a thorough physical examination. An enlarged uterus may be evident during a pelvic exam. If ultrasound technology is used, it cannot definitively diagnose adenomyosis, but it allows physicians to visualize the uterus, the uterine lining and its muscular wall so he/she can rule out other health conditions with similar symptoms.
Depending upon each woman's symptoms and the preferences of the physician, at times sonohysterography is performed. This involves the injection of saline solution via a tiny tube into the uterus prior to beginning an ultrasound.
Treatment & Therapy
The treatment for this condition is dependent upon the symptoms of each woman, symptom severity, and whether the woman has completed childbearing. Over-the-counter medications can be used to treat mild symptoms, along with a heating pad to relieve discomfort from menstrual cramps. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed by a physician to relieve mild pain. Typically, NSAIDs are started one to two days prior to the beginning of menstruation and continue throughout the first few days.
Hormonal therapies such as progestin, birth control pills, aromatase inhibitors, gonadotropin-releasing hormone analogue, levonorgestrel-releasing intrauterine contraceptive devices may be used to control symptoms of heavy or painful menstruation.
Physicians may choose to perform uterine artery embolization, which is a minimally invasive procedure using tiny particles to block the blood vessels that supply the adenomyosis with blood. A tiny tube inserted into the vagina and through the cervix is used to guide the particles. Adenomyosis shrinks as a result of blocking the blood supply.
Depending upon each woman's condition, endometrial ablation may also be used. This is another minimally invasive procedure that works by destroying the lining of the uterus. This procedure has been proven effective in relieving symptoms in women when adenomyosis had not penetrated too deeply into the muscle wall of the uterus.
In cases where symptoms are severe, a hysterectomy may be necessary. This is the surgical removal of the uterus. The surgeon can use various surgical methods to do this including a laparoscopic hysterectomy, vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy.
Prevention & Prophylaxis