Adenomyosis occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to respond to hormonal changes normally like normal endometrial tissue — thickening, breaking down, and bleeding — during each menstrual cycle. Sometimes these changes can occur focally then it is known as Adenomyoma.
This is a common condition and most often diagnosed in middle-aged women and women who have had children in their 40s and 50s. Adenomyosis in these women could relate to longer exposure to estrogen compared with that of younger women. However, current research suggests that the condition might also be common in younger women.
- Heavy, prolonged menstrual bleeding.
- Severe menstrual cramps.
- Abdominal pressure and bloating.
- Pain in the lower abdomen.
- Painful intercourse.
- Prior uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C), etc
- Childbirth
- Middle age
- Hereditary
Your doctor may suspect adenomyosis based on:
- Signs and symptoms.
- A pelvic exam reveals an enlarged, tender uterus.
- Ultrasound imaging of the uterus- This is the most important modality to diagnose Adenomyosis.
- Magnetic resonance imaging (MRI) Of the pelvis- Sometimes when in doubt especially in young adolescents this modality is used.
Adenomyosis often resolves after menopause as hormones needed for changes in the endometrium are no more secreted from the
ovary. Treatment options for adenomyosis include:
Anti-inflammatory drugs Your doctor might recommend anti-inflammatory medications, such as ibuprofen or Tranexamic acid with Mefenamic acid to control the pain and bleeding. By starting an anti-inflammatory medicine one to two days before your period begins and taking it during your period, you can reduce menstrual blood flow and help relieve pain.
- Combined estrogen-progestin birth control pills.
- Progestin-only contraception, such as an intrauterine device like Mirena.
- Continuous use of birth control pills often causes amenorrhea — the absence of your menstrual periods — which might provide some relief.
Conservative surgery involving endomyomertial ablation, laparoscopic myometrial electrocoagulation or excision has proven to be effective in >50% of patients, although follow-up is necessary.
Hysterectomy- If your pain is severe and no other treatments have worked, your doctor might suggest surgery to remove your uterus. Removing your ovaries isn’t necessary to control adenomyosis. Hysterectomy always relieves the patient from all the symptoms in severe cases of adenomyosis
