Overview

Adenomyosis is a gynecological condition in which the inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (myometrium). This can cause the uterus to become enlarged, leading to heavy menstrual bleeding, painful periods, and pelvic discomfort. While adenomyosis is considered a benign (non-cancerous) condition, it can significantly affect a woman’s quality of life. The condition most commonly affects women in their 30s and 40s, especially those who have had children, but it can occur at any reproductive age.

Causes

The exact cause of adenomyosis is not fully understood, but several contributing factors have been suggested:

• Hormonal factors: Estrogen plays a key role in adenomyosis development, which is why the condition typically resolves after menopause.
• Childbirth: Trauma to the uterus during childbirth or cesarean section may contribute to the breakdown of the endometrial boundary.
• Uterine surgeries: Previous uterine procedures such as dilation and curettage (D&C) can increase the risk of adenomyosis.
• Inflammation: Chronic inflammation in the uterine lining may promote the invasion of endometrial tissue into the muscular wall.
• Developmental factors: Some researchers suggest adenomyosis may originate from endometrial tissue misplaced during fetal development.

Symptoms

The symptoms of adenomyosis can range from mild to severe, and some women may not experience any symptoms at all. Common symptoms include:

• Heavy menstrual bleeding: Menstrual periods that last longer than usual and involve excessive bleeding (menorrhagia).
• Severe menstrual cramps: Intense pain during menstruation (dysmenorrhea) that worsens over time.
• Chronic pelvic pain: Ongoing lower abdominal discomfort or pressure throughout the menstrual cycle.
• Pain during intercourse: Discomfort or pain during sexual activity (dyspareunia).
• Enlarged uterus: A feeling of heaviness or bloating in the pelvis due to uterine enlargement.
• Blood clots: Passage of large clots during menstruation.

Diagnosis

Diagnosing adenomyosis involves a combination of medical history, physical examination, and imaging tests:

• Pelvic examination: A doctor may feel an enlarged or tender uterus during a manual examination.
• Ultrasound: Transvaginal ultrasound helps visualize uterine abnormalities, although adenomyosis can sometimes be difficult to distinguish from other conditions.
• MRI (Magnetic Resonance Imaging): MRI provides a more detailed view of the uterus and is helpful in confirming adenomyosis.
• Endometrial biopsy: Though not diagnostic for adenomyosis, a biopsy may be performed to rule out other conditions like endometrial hyperplasia or cancer.
• Exclusion of other causes: Conditions like uterine fibroids and endometriosis may present with similar symptoms and need to be ruled out.

Treatment

Treatment for adenomyosis depends on symptom severity, age, and reproductive goals:

• Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce menstrual pain.
  • Hormonal therapies such as birth control pills, hormonal IUDs, or progestin therapy to manage bleeding and pain.
  • Gonadotropin-releasing hormone (GnRH) agonists to reduce estrogen levels temporarily, shrinking adenomyotic tissue.
• Minimally invasive procedures:
  • Endometrial ablation may reduce bleeding but is not suitable for women wanting to have children.
  • Uterine artery embolization (UAE) reduces blood flow to the uterus, potentially shrinking adenomyotic tissue.
• Surgery: In severe cases, hysterectomy (removal of the uterus) offers a definitive cure and is recommended when other treatments fail and childbearing is complete.

Prognosis

The prognosis for adenomyosis depends on the chosen treatment and individual factors:

• Symptom control: Many women achieve significant relief from symptoms through medications or minimally invasive treatments.
• Chronic nature: Adenomyosis is a chronic condition, and symptoms may return after stopping medical therapy.
• Resolution after menopause: Symptoms often resolve naturally after menopause due to decreased estrogen levels.
• Definitive cure: Hysterectomy provides complete relief from adenomyosis symptoms in cases of severe disease.
• Quality of life: With appropriate treatment, most women experience an improved quality of life and symptom control.

Early recognition and treatment can greatly improve comfort and daily functioning for women affected by adenomyosis.