Overview
Adenomyosis is a medical condition in which the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to function normally during each menstrual cycle, resulting in an enlarged uterus and potentially heavy, painful periods. The exact cause of adenomyosis is unknown, but hormonal imbalances and previous uterine surgery may play a role. It is more common in women in their 40s and 50s, but current research suggests it may also affect younger women. Symptoms may include heavy or prolonged menstrual bleeding, severe cramping or pelvic pain, and pain during intercourse. Treatment options may include hormonal therapy or, in severe cases, hysterectomy.
Understanding the disease
Risk Factors
Risk factors for developing adenomyosis include prior uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C), childbirth, and middle age. Adenomyosis tends to occur more commonly in women in their 40s and 50s, possibly due to longer exposure to estrogen. However, the condition can also affect younger women.
Development
Adenomyosis can develop through various theories, although the exact cause is still unknown. Some of the proposed mechanisms include:
- Developmental origins: According to one theory, the endometrial tissue may be deposited in the uterine muscle during fetal development.
- Uterine inflammation related to childbirth: Another theory suggests a link between adenomyosis and childbirth. Inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
- Stem cell origins: A recent theory proposes that bone marrow stem cells may invade the uterine muscle, causing adenomyosis. Regardless of the development mechanism, adenomyosis depends on the body's circulating estrogen for growth. Risk factors for adenomyosis include prior uterine surgery, childbirth, and middle age.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect adenomyosis and experience any of the following symptoms: heavy or prolonged menstrual bleeding, severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea), chronic pelvic pain, painful intercourse (dyspareunia), or if the symptoms appear for no apparent reason, continue to enlarge, or have been present for two to four weeks. Additionally, if you experience any of the following, you should consult a healthcare provider: abdominal pain, blood in your stool, a change in your bowel habits that lasts longer than a week.
Diagnosis
Adenomyosis can be challenging to diagnose due to the similarity of its symptoms to other uterine conditions, such as fibroid tumors, endometriosis, and endometrial polyps. To diagnose adenomyosis, your doctor may follow these steps:
- A pelvic exam to check for signs of an enlarged, tender uterus.
- Imaging tests, such as ultrasound and magnetic resonance imaging (MRI), to detect any abnormalities in the uterus.
- In some cases, your doctor might perform an endometrial biopsy to rule out other serious conditions, but this alone won't confirm a diagnosis of adenomyosis. The definitive diagnosis of adenomyosis can only be made by examining the uterus after hysterectomy. Treatment options for adenomyosis may include self-care measures, medications, or surgery, depending on the severity of symptoms and how close the patient is to menopause.
Management and Treatment
Complications
Complications of adenomyosis may include anemia due to prolonged, heavy bleeding, disruption of daily activities and lifestyle due to pain and excessive bleeding, and the development of other conditions such as high blood pressure, high cholesterol, heart problems, osteoarthritis, type 2 diabetes, thyroid gland enlargement, precancerous colon growths, sleep apnea, carpal tunnel syndrome, increased risk of cancerous tumors, spinal cord compression or fractures, vision changes or vision loss. Early treatment of adenomyosis can prevent these complications from developing or becoming worse.
Treatment
Adenomyosis can be treated with medications, hormonal therapy, and in some cases, surgery. Medical treatments include anti-inflammatory drugs, hormone medications, and pain relief medication. Hormone medications like combined estrogen-progestin birth control pills, progestin-only contraception, or continuous-use birth control pills can help alleviate heavy bleeding and pain. In severe cases, your doctor may suggest surgery, such as a hysterectomy. For self-care, you can try warm baths, heating pads, over-the-counter anti-inflammatory medications like ibuprofen, and practicing relaxation techniques. It is important to consult with your doctor to determine the best treatment plan based on your individual symptoms and medical history.
Preparing for medical consultation
To prepare for an appointment for adenomyosis, you should make a list of your symptoms, medical history, including menstrual and childbirth history, and any medications or supplements you are currently taking. It's also a good idea to bring a family member or friend with you to the appointment for support and to help remember important details from the visit. Additionally, you should be aware of any pre-appointment restrictions, such as dietary or activity limitations, and write down questions to ask your doctor. Some basic questions to ask your healthcare provider about adenomyosis may include inquiries about medications to improve symptoms, circumstances under which surgery might be recommended, and the impact of the condition on fertility. Being well-prepared and proactive can help you make the most of your time with your healthcare provider and ensure that you receive the best possible care for your adenomyosis.