Adenomyosis is a common disorder in which the tissue that normally lines the womb grows inside the muscular walls of the womb. The resultant extra tissue leads to a painful menstrual cycle and pelvic pain. This disease is also known as uterine endometriosis. Adenomyosis is benign in nature, i.e. it is not cancerous. Adenomyosis results in swelling up of the uterus, sometimes to even two or three times its original size. It generally affects women over the age of 35. Adenomyosis is more common in women with high levels of estrogen. This condition disappears after menopause (a year after a woman’s final period), this is because estrogen levels drop after menopause.
The exact cause of Adenomyosis is not known, but research points out to the following factors:
- Invasive growth of tissue: According to some experts this condition is a result of direct invasion of endometrial cells into the muscle forming the uterine walls from the lining of the uterus. Incisions made near the uterus during C-section may lead to direct invasion of the endometrial cells into the wall of the womb (uterus).
- Uterine inflammation due to childbirth: Other experts suggest a link between childbirth & adenomyosis i.e. inflammation of the uterus during the first menstrual period after child birth (postpartum periods) results in breaking of the normal boundary of the uterine wall which causes adenomyosis.
- Stem cells: According to a recent theory, bone marrow stem cells invade the uterine musculature leading to adenomyosis.
The factors below enhance the risk of adenomyosis:-
- Uterine surgery: Prior surgeries involving the uterine area for example fibroid removal or C-section can lead to adenomyosis.
- Childbirth: As discussed above in the causes section, uterine inflammation due to child birth may result in adenomyosis.
- Middle age: Women in their 30s are more likely to suffer from adenomyosis.
It is possible that one may not experience any symptoms at all, while on the other hand some women may experience mild to severe symptoms. Most of the symptoms are related to the menstrual cycle. Symptoms during menstrual cycle:
- Severe cramps
- Heavy menstrual bleeding
- Prolonged cycle
- Clotting during menstrual cycle
Other symptoms affect the abdomen area:
- Pressure or bloating in the area.
- Tenderness around the abdomen
Diagnosis of adenomyosis can be difficult, mainly due to the fact that there are some conditions (fibroids and endometriosis) which exhibit similar symptoms. Also, before the advent of MRI scans and Ultrasound imaging the only way to diagnose adenomyosis was hysterectomy. Let’s discuss these procedures in detail:
- Ultrasound: The ultrasound technique used to diagnose adenomyosis is known as transvaginal ultrasound scan. Here the doctor inserts the ultrasound device 2-3 inches into the vaginal opening in order to ascertain the disorder.
- MRI: If the doctor is unable to determine adenomyosis with ultrasound he/she may order a MRI scan of the uterus. It should be noted that MRI is not an option pregnant women.
The method of treatment depends on factors such as:
- Desire for childbirth
- The number of years the patient is away from reaching her menopause.
Anti-inflammatory medicines: If the patient is nearing menopausal age then anti-inflammatory medicines can be used to subdue the pain till she reaches menopause. Anti-inflammatory drugs reduce the menstrual blood flow and help in controlling the pain. The medicines should be taken 2-3 days before the start of the menstrual cycle and should be continued in the cycle as well.
Hormone medications: Hormone medications include birth control pills containing combined estrogen-progestin, vaginal rings and hormone containing patches. They are used to lessen the severe bleeding & pain associated with adenomyosis. Progestin only birth control pills are known to cause absence of menstrual periods which may help in providing relief from symptoms.
Specific surgical treatment for women requiring conservation of uterus:- Women experiencing symptoms due to adenomyomas – the focal region of adenomyosis resulting in a mass, may undergo laparoscopic resection or removal of these lesions. This procedure does not involve removal of uterus and thus preserves fertility and uterine function.
Hysterectomy: If your pain is extremely severe and menopause is years away then hysterectomy is considered. Hysterectomy is the only treatment to completely cure adenomyosis. Hysterectomy is a procedure wherein the womb/uterus is removed, therefore such an option should be only pursued to if the patient as no desire of childbirth. Your ovaries are not affected by adenomyosis and can be left in the body.