Sometimes, adenomyosis produces no signs or symptoms, or only mild discomfort. However, when it does present symptoms, adenomyosis can result in:
- Heavy or prolonged periods
- Severe cramping or sharp, knifelike pelvic pain during menstruation
- Chronic pelvic pain
- Painful intercourse
- Tenderness or swelling in your abdomen (which may indicate an enlarged uterus)
What Causes Adenomyosis?
We don’t know for sure. We know there is some link to endometriosis, a condition where cells from the lining of the womb are found outside the uterus. Adenomyosis often co-exists with fibroids, adenomyosis is routinely misdiagnosed as fibroids.
Despite this, some experts have developed a number of theories for what might cause adenomyosis:
- Tissue growth - some experts believe that endometrial cells, from the lining of the uterus, invade the muscle of the uterine walls.
- During development - some experts believe endometrial tissues ends up in the uterine muscle when the fetus is first formed.
- Childbirth - other experts believe a link exists between adenomyosis and childbirth, where inflammation of the uterine lining during postpartum periods can break the normal boundary of the cells that line the uterus.
- Stem cells - a recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.
What are the Risk Factors for Developing Varicoceles?
Most cases of adenomyosis are found in women in their 40s and 50s. This could be due to longer exposure to estrogen than younger women, however recent research does suggest adenomyosis is just as common in younger women.
Risk factors for adenomyosis include:
- Prior uterine surgery, such as a C-section or fibroid removal.
- Middle age
How is Adenomyosis Diagnosed?
Adenomyosis can be identified on transvaginal ultrasound but is often missed. An MRI of the pelvis is far more sensitive for detection of adenomyosis as well as allowing identification of all fibroids and other potential causes of symptoms such as endometriosis. Accurate diagnosis is important as this affects treatment options.
Adenomyosis and Fertility
Recent studies, using improved diagnostic tools, suggests that adenomyosis does have an impact on fertility, both spontaneous and assisted.
A recent meta-analysis found that during IVF, success rates were significantly lower in women in adenomyosis, and the risk of miscarriage was higher.
Unfortunately, there is still more to be understood around how adenomyosis contributes to infertility, and research in the area is ongoing.
Adenomyosis versus Endometriosis
While adenomyosis and endometriosis are similar, they are in fact two separate conditions. The major differences can be described as ‘inside vs outside’.
With endometriosis, the cells that line the uterus also grow on the outside. This can lead to issues with nearby organs such as your ovaries and the growth can breach them.
Adenomyosis happens when the cells that line your uterus also grow deep in the uterine wall and thicken it.
Only patients who are symptomatic need treatment. The majority of women with adenomyosis will not be symptomatic. When they occur however symptoms can be debilitating. If you are concerned by any of the following then you may wish to consider treatment:
- Heavy bleeding with frequent changes of pads
- Having to wear double pads
- Passing large clots
- Tiredness due to anaemia
- Concerns over periods limit your work, social life or normal activities
There are a range of treatment options, and finding the one best suited to you involves speaking with your doctor, or a specialist such as an Interventional Radiologist, to discuss your exact situation and needs.
How is Adenomyosis Managed and Treated?
For mild cases, medication such as ibuprofen can be used to reduce blood flow during your period and relieve severe cramps.
Hormonal treatments can help to control increased estrogen levels that may be contributing to your symptoms. Treatments include contraceptives, such as birth control pills.
This involves removing or destroying the lining of the uterine cavity (the endometrium). This is not a suitable treatment for everyone since adenomyosis often invades deep into the muscle.
A hysterectomy is the surgical removal of the uterus. It’s a major surgical intervention with serious side effects, and only suitable for women who don’t plan on having any more children.
The first-line treatment option is medical management. Undoubtedly symptoms are best managed by an individual patient-centered approach and some women would be best served by surgery and others by embolisation. When you are seen in rooms by the IR specialist you can trust that you will be offered treatment only if it is thought to be the best option for you as an individual.
Uterine Artery Embolisation
This minimally invasive approach is almost identical to Uterine Fibroid Embolisation, performed for uterine fibroids. This allows significant symptom control in a majority of patients and can prevent the need for hysterectomy. This procedure is performed by an Interventional Radiologist, is minimally invasive and avoids scar tissue developing in the uterus.