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Adenomyosis

What is adenomyosis?

Adenomyosis is a condition that involves the encroachment, or movement, of the endometrial tissue that lines the uterus into the muscles of the uterus. This makes the uterine walls grow thicker. It may lead to heavy or longer-than-usual menstrual bleeding, as well as pain during your menstrual cycle or intercourse.

The exact cause of this condition is unknown. However, it’s associated with increased levels of estrogen. Adenomyosis usually disappears after menopause (12 months after a woman’s final menstrual period). This is when estrogen levels decline.

There are several theories about what causes adenomyosis. These include:

  • extra tissues in the uterine wall, present before birth, that grow during adulthood
  • invasive growth of abnormal tissues (called adenomyoma) from endometrial cells pushing themselves into the uterine muscle — this may be due to an incision made in the uterus during surgery (such as during a cesarean delivery) or during normal uterine functioning
  • stem cells in the uterine muscle wall
  • uterine inflammation that occurs after childbirth — this may break the usual boundaries of the cells that line the uterus
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Risk factors

Risk factors for adenomyosis

The exact cause of adenomyosis is unknown. However, there are factors that put women at greater risk for the condition. These include:

  • being in your 40s or 50s (before menopause)
  • having children
  • having had uterine surgery, such as a cesarean delivery or surgery to remove fibroids

Symptoms

Symptoms of adenomyosis

Symptoms of this condition can be mild to severe. Some women may not experience any at all. The most common symptoms include:

  • prolonged menstrual cramps
  • spotting between periods
  • heavy menstrual bleeding
  • longer menstrual cycles than normal
  • blood clots during menstrual bleeding
  • pain during sex
  • tenderness in the abdominal area
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Diagnosis

Diagnosing adenomyosis

A complete medical evaluation can help to determine the best course of treatment. Your doctor will first want to perform a physical exam to determine if your uterus is swollen. Many women with adenomyosis will have a uterus that’s double or triple the normal size.

Other tests may also be used. An ultrasound can help your doctor to diagnose the condition, while also ruling out the possibility of tumors on the uterus. An ultrasound uses sound waves to produce moving images of your internal organs — in this case, the uterus. For this procedure, the ultrasound technician (sonographer) will place a liquid conducting gel on your abdomen. Then, they’ll place a small handheld probe over the area. The probe will produce moving images on the screen to help the sonographer see inside the uterus.

Your doctor may order an MRI scan to obtain high-resolution images of the uterus if they’re unable to make a diagnosis using an ultrasound. An MRI uses a magnet and radio waves to produce pictures of your internal organs. This procedure involves lying very still on a metal table that will slide into the scanning machine. If you’re scheduled to have an MRI, be sure to tell your doctor if there’s any chance you’re pregnant. Also, be sure to tell your doctor and the MRI technologist if you have any metal parts or electrical devices inside your body, such as a pacemaker, piercings, or metal shrapnel from a gun injury.

Treatment

Treatment options for adenomyosis

Women with mild forms of this condition may not require medical treatment. Your doctor may recommend treatment options if your symptoms interfere with your daily activities.

Treatments aimed at reducing the symptoms of adenomyosis include the following:

Anti-inflammatory medications

An example is ibuprofen. These medications can help to reduce blood flow during your period while also relieving severe cramps. The Mayo Clinic recommends starting anti-inflammatory medication two to three days before the start of your period and continuing to take it during your period. You should not use these medications if you’re pregnant.

Hormonal treatments

These include oral contraceptives (birth control pills), progestin-only contraceptives (oral, injection, or an intrauterine device), and GnRH-analogs such as Lupron (leuprolide). Hormonal treatments can help to control increased estrogen levels that may be contributing to your symptoms. Intrauterine devices, such as Mirena, can last up to five years.

Endometrial ablation

This involves techniques to remove or destroy the endometrium (lining of the uterine cavity). It’s an outpatient procedure with a short recovery time. However, this procedure may not work for everyone, since adenomyosis often invades the muscle more deeply.

Uterine artery embolization

This is a procedure that prevents certain arteries from supplying blood to the affected area. With the blood supply cut off, the adenomyosis shrinks. Uterine artery embolization is typically used to treat another condition, called uterine fibroids. The procedure is performed in a hospital. It usually involves staying overnight afterward. Since it’s minimally invasive, it avoids scar formation in the uterus.

MRI-guided focused ultrasound surgery (MRgFUS)

MRgFUS uses precisely focused high-intensity waves to create heat and destroy the targeted tissue. The heat is monitored using MRI images in real time. Studies have shown this procedure to be successful in providing relief of symptoms. However, more studies are needed.

Hysterectomy

The only way to completely cure this condition is to have a hysterectomy. This involves complete surgical removal of the uterus. It’s considered a major surgical intervention and is only used in severe cases and in women who don’t plan to have any more children. Your ovaries don’t affect adenomyosis and may be left in your body.

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Complications

Potential complications of adenomyosis

Adenomyosis isn’t necessarily harmful. However, the symptoms can negatively affect your lifestyle. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities such as sexual intercourse.

Women with adenomyosis are at an increased risk of anemia. Anemia is a condition often caused by an iron deficiency. Without enough iron, the body can’t make enough red blood cells to carry oxygen to the body’s tissues. This can cause fatigue, dizziness, and moodiness. The blood loss associated with adenomyosis can reduce iron levels in the body and lead to anemia.

The condition has also been linked with anxiety, depression, and irritability.

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Outlook

Long-term outlook

Adenomyosis isn’t life-threatening. Many treatments are available to help alleviate your symptoms. A hysterectomy is the only treatment that can eliminate them altogether. However, the condition often goes away on its own after menopause.

Adenomyosis isn’t the same as endometriosis. This condition occurs when the endometrial tissues become implanted outside of the uterus. Women with adenomyosis may also have or develop endometriosis.

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