Adenomyosis is a condition that involves the movement (encroachment) of endometrial tissues, which normally line the uterus, into the muscles of the uterus. This causes thickening of the uterine walls, which can cause heavy or longer-than-usual menstrual bleeding as well as pain during the menstrual cycle or intercourse.
The exact cause of this condition is unknown. However, it is prevalent in women with increased levels of estrogen, and usually disappears after menopause (12 months after a woman’s final menstrual period), when estrogen levels decline.
Theories regarding the cause of adenomyosis include:
- extra tissues distributed within the uterine wall before birth that grow during adulthood
- invasive growth of abnormal tissues (also called adenomyoma) from endometrial cells pushing themselves into the uterine muscle, perhaps due to an incision made in the uterus (as occurs during a cesarean delivery)
- stem cells occupying the uterine muscle wall
- uterine inflammation that occurs after childbirth, which may break the usual boundaries of the cells that line the uterus
While the exact cause of adenomyosis is unknown, 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 for a cesarean section or to remove fibroids (Mayo)
Symptoms of this condition can be mild to severe. Some women may not experience any signs 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
- tender abdominal area
This condition may clear up on its own. However, symptoms may become too uncomfortable to bear. A complete medical evaluation can help to determine the best course of treatment.
Your doctor will first want to determine if your uterus is swollen through a physical exam. Many women with adenomyosis have uteruses that are 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, your doctor will place a liquid conducting gel onto your abdomen, which may feel a little cold. Then, he or she will place a small handheld probe over the area, which will then produce moving images onto the screen.
Your doctor may order a magnetic resonance imaging (MRI) scan to get a clearer image of the uterus if he or she is 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 are scheduled to have an MRI, be sure to tell your doctor if there is any chance you are pregnant, or if you have any metal parts or electrical devices inside your body, such as a heart pacemaker or shrapnel from a gun injury.
Women with mild forms of this condition may not require medical treatment. However, your doctor may recommend treatment options if your symptoms interfere with your daily activities. Anti-inflammatory medications, such as ibuprofen, can help to reduce blood flow during your period while also relieving severe cramps. The Mayo Clinic recommends starting anti-inflammatory medication at least two days before the start of your menstrual cycle (Mayo).
Oral contraceptives can help to control increased estrogen levels that may be contributing to uncomfortable symptoms. In some cases, your doctor might recommend progestin-only contraceptives, which stop your period entirely.
The only way to completely cure this condition is to have a hysterectomy, which is a surgical removal of the uterus. This solution is only used in severe cases and in women who don’t plan to have any more children. Your ovaries may be left in your body, as they don’t affect adenomyosis.
This condition isn’t necessarily harmful. However, the symptoms can adversely affect your lifestyle. Some patients have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities, including sexual intercourse.
Women with adenomyosis are at an increased risk of anemia. Anemia is a condition often caused by an iron deficiency. Without adequate iron, the body cannot make enough red blood cells to carry oxygen to the body’s tissues. This can cause fatigue, dizziness, and moodiness. The excessive blood loss associated with adenomyosis can lead to a reduction of iron levels in the body, which can lead to anemia.
Adenomyosis has also been linked with anxiety, depression, and irritability.
This condition is not life threatening, but treatment can help alleviate your symptoms. A hysterectomy is the only procedure that can eliminate them altogether. In many cases, the condition may go away on its own after menopause.
Adenomyosis is not the same as endometriosis, which occurs when the endometrial tissues become implanted outside of the uterus. However, women with adenomyosis may also have or develop endometriosis.