Adenomyosis

Description

Adenomyosis (ad-uh-no-my-O-sis) occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. The displaced tissue continues to act normally-thickening, breaking down and bleeding-during each menstrual cycle. An increase in the size of the uterus and painful, heavy periods can result.

The doctors are not sure what causes adenomyosis, but the disease usually resolves after menopause. For women who have severe discomfort from adenomyosis, hormonal treatments can help. The removal of the uterus (hysterectomy) cure adenomyosis

Symptoms

Sometimes, adenomyosis causes no signs or symptoms, or only mild discomfort. However, adenomyosis can cause:

  • Heavy or prolonged menstrual bleeding
  • Severe cramping or sharp, pelvic pain during menstruation (dysmenorrhea)
  • Chronic pelvic pain
  • Painful intercourse (dyspareunia)

The uterus may be larger. Although you may not know if the uterus is larger, you may notice tenderness or pressure in the lower abdomen.

When to see a doctor

If you have prolonged bleeding or severe cramping during their periods that it interferes with your regular activities, make an appointment to see your doctor.

Causes

The cause of adenomyosis is not known. There have been many theories, including:

  • Invasive growth of the tissues. Some experts believe that the cells of the endometrium, the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (c-section) mystruggle to promote the direct invasion of the endometrial cells in the wall of the uterus.
  • The origins of the development. Other experts suspect that the endometrial tissue is deposited in the uterine muscle when the uterus is formed for the first time in the fetus.
  • Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. The inflammation of the lining of the uterus during the postpartum period could cause a break in the normal limit of the cells lining the uterus.
  • Stem cells of origin. A recent theory proposes that the bone marrow stem cells could invade the uterine muscle, causing the adenomyosis.

Regardless of how adenomyosis develops, its growth depends on the body's circulating estrogen.

Risk factors

The risk factors for adenomyosis include:

  • Before uterine of the surgery, such as the C-section, fibroid removal, or dilation and curettage (D&C)
  • Delivery
  • The middle ages

Most cases of adenomyosis — that depends on the estrogen found in women in their 40s and 50s. Adenomyosis in these women might relate more exposure to estrogen in comparison with the younger women. However, the current research suggests that the condition may also be common in younger women.

Complications

If you have often prolonged, heavy bleeding during menstruation, you can develop chronic anemia, which causes fatigue and other health problems.

Although it is not harmful, pain, and excessive bleeding associated with adenomyosis can alter your life-style. You can avoid the activities that I have enjoyed in the past, because you are in pain or concern that you may start to bleed.

Adenomyosis

Diagnosis

Some other uterine conditions can cause signs and symptoms similar to those of adenomyosis, making adenomyosis difficult to diagnose. These conditions include fibroid tumors (leiomyomas), uterus cells grows outside the uterus (endometriosis) and growths in the lining of the uterus (endometrial polyps).

Your doctor might lead to the conclusion that you have adenomyosis only after ruling out other possible causes for your signs and symptoms.

Your doctor may suspect adenomyosis based on:

  • Signs and symptoms
  • A pelvic examination reveals that the enlarged uterus
  • Ultrasound imaging of the uterus
  • Magnetic resonance imaging (MRI) of the uterus

In some cases, your doctor may take a sample of uterine tissue for testing (biopsy of the endometrium) to ensure that you do not have a more serious condition. But a biopsy of the endometrium will not help your doctor confirm a diagnosis of adenomyosis.

The pelvis imaging such as ultrasound and Magnetic resonance imaging (MRI) can detect signs of adeno -myosis, but the only way to confirm is to examine the uterus after hysterectomy.

Treatment

Adenomyosis often disappears after menopause, so the treatment will depend on how close you are to that stage of life.

Treatment options for adenomyosis include:

  • Anti-inflammatory drugs. Your doctor may recommend nonsteroidal anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medication for one to two days before your period begins and to take it during your period, you can reduce menstrual blood flow and help relieve pain.
  • Hormonal medications. The combination of estrogen-progestin birth control pills or hormone containing patch, or the vaginal ring may reduce the heavy bleeding and pain associated with adenomyosis. Proges-tin-only contraception, such as an intrauterine device, or the continuous use of birth control pills often cause amenorrhea — absence of menstrual periods that may provide some relief.
  • The hysterectomy. If the pain is severe and other treatments have not worked, your doctor may suggest surgery to remove the uterus. The removal of the ovaries is not necessary for the control of adenomyosis.

Self-care

To relieve the pelvic pain and cramps associated with adenomyosis, try these tips:

  • Soaking in a hot bath.
  • Use a heating pad on the abdomen.
  • Take an over-the-counter anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, others).

Preparing for your appointment

Your first appointment will be with your primary care provider or your gynecologist.

What you can do

Make a list of:

  • Its signs and symptoms, and when they began
  • All the drugs, vitamins, and other supplements that you are taking, including the dosage
  • Medical information, including menstruation and childbirth history
  • Questions to ask your doctor

For adenomyosis, basic questions to ask your doctor include:

  • There are medications you can take to improve my symptoms?
  • Under what circumstances is it recommended to the surgery?
  • Could my condition affects my ability to get pregnant?

Ddon't hesitate to ask other questions.

What to expect from your doctor

Your doctor might ask you to:

  • When the symptoms tend to occur?
  • How severe are the symptoms?
  • When was your last period?
  • Could you be pregnant?
  • Using a method of birth control? If so, what?
  • Do your symptoms seem to be related to your menstrual cycle?
  • Nothing seems to improve the symptoms?
  • Does anything make your symptoms worse?
Symptoms and treatment of Adenomyosis