Adenomyosis is a common condition in women occurring later in their childbearing years. Around 60 percent of women over 30 may have adenomyosis, but many never suffer from any symptoms. For those who do, treatment with medications and or surgery is available. Adenomyosis is a thickening of the uterine lining which occurs when endometrial tissue moves to the outer muscular walls of the uterus. Endometriosis is a different condition where endometrial tissue becomes implanted outside of the uterus. However, many women who suffer from adenomyosis also have endometriosis, and many of the symptoms are similar.
The most typical symptoms of adenomyosis include heavy or prolonged menstrual bleeding sometimes with clots, painful periods (dysmenorrheal), cramping throughout menstruation, painful intercourse, and bleeding between periods. The uterus may also be enlarged or tender. Although some women may suffer from all of these symptoms, others will only have a few, and still others may experience no symptoms at all. Treatments will vary depending on the symptoms that are present.
Experts are not certain about the exact cause of adenomyosis, but there are several theories. Some think endometrial cells invade the muscles of the uterine wall particularly during uterine surgery like a caesarian section. Others believe that adenomyosis begins in utero when the uterine lining is being formed and there occurs an overlap of the myometrium (uterine wall) and the endometrial tissue. Some experts speculate that adenomyosis involves postpartum (after childbirth) inflammation of the endometrium that may break down the normal boundaries of the uterus and its muscle walls.
Further research may one day resolve these various explanations, but all are in agreement that estrogen in a woman’s body will affect the growth of adenomyosis, which is why it is most often resolved following the decrease of estrogen during menopause. A woman’s proximity to menopause will be considered in treatment methods. Women with adenomyosis will be diagnosed through evaluation of their symptoms. Health care providers may also order several tests to confirm a diagnosis, including a pelvic exam to feel for tenderness or enlargement of the uterus. Your provider may also order an ultrasound and/or MRI (magnetic resonance imaging) of the uterus. In some instances, a biopsy of the uterine lining may also be done to rule out any other cause for the abnormal bleeding. A biopsy is a tool to rule out other conditions but will not confirm a diagnosis of adenomyosis. The only conclusive test for adenomyosis is examination of the endometrium after a hysterectomy has been performed.
Hysterectomy is the definitive cure for adenomyosis but is by no means the only treatment for the condition. Treatments options include use of anti-inflammatory drugs, like ibuprofen, which may lessen pain and decrease blood flow during menstruation. Additionally, hormone therapies like birth control pills, IUDs, patches, and vaginal rings which contain either estrogen, progestin or both may be used to lessen menstrual symptoms which can affect adenomyosis. Which treatment option is right for you will depend on several factors, including the severity of your symptoms, your age and menopause status, and your risk factors for surgery or medication options.
While adenomyosis is not the easiest gynecological condition to diagnose, it is usually very treatable, and most women have favorable results from the treatment options available. Seek advice from your health care professional if you suffer from any of these troubling symptoms.
Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.