Adenomyosis is a disorder characterised by the breaking of the endometrium (innermost lining of the uterus) into the myometrium (muscular layer of the uterus). The condition can either affect the entire uterus or be confined to a single location. It is also known as endometriosis of the uterus. As these tissues respond to monthly hormonal changes, period blood may get trapped within the muscle layer, which can result in an enlarged, hard and inelastic uterus. Though considered a benign condition, women with adenomyosis can require medical intervention if their symptoms significantly lower the quality of their life.
Adenomyosis: Common Symptoms
While some women with adenomyosis are asymptomatic and experience no symptoms, others may have:
- Prolonged, heavy and/or clotted bleeding during menstruation
- Severe cramps or knife-like pain during menstruation
- Abdominal pain throughout the month
- Painful intercourse
- Abdominal pressure
- Abdominal bloating
- Nausea and vomiting during a period
Some studies indicate that adenomyosis may cause or play a role in fertility problems. It is also associated with a higher risk of miscarriage, and there are reported cases of uterine rupture due to severely damaged muscle of uterus.
Adenomyosis: Causes and Risk Factors
Despite the fact that adenomyosis is a common disorder, its precise cause isn’t known. Research has demonstrated that the growth of adenomyosis is associated with excess oestrogen levels. This explains why the problem frequently disappears when women reach menopause.
Some studies indicate that women who have undergone uterine surgery (C-section, suction and curettage) in the past may be at risk for adenomyosis. Other studies link it with the uterine inflammation caused by childbirth. None of these hypotheses have been conclusively proven, however, there are known genetic links.
Adenomyosis: Diagnostic Tests
If he suspects that you have adenomyosis, Dr G may suggest one or some of the following tests to confirm his diagnosis. These include:
- Pelvic exam. If your uterus is enlarged and tender, it is possible for Dr G to detect it through a physical, pelvic exam.
- Ultrasound. This imaging technique will allow DR G to examine your uterus, the uterine lining, and its muscular wall. While an ultrasound may not definitively diagnose the condition, it can help rule out disorders that have similar symptoms.
- MRI. This technique is used to diagnose adenomyosis in women who experience abnormal bleeding. It may show damaged muscles.
Since there are several conditions that have symptoms similar to those of adenomyosis, the right diagnosis is vital to treating your condition successfully. However, up to 60% of adenomyosis is only diagnosed via tissue pathology amongst women who have undergone a hysterectomy.
Adenomyosis: Treatment Options
The treatment options that Dr G recommends you will be based on several factors, including the severity of your condition, the extent of the problem, and whether you wish to conceive in the future. While mild symptoms can be treated with over-the-counter painkillers and hot water bottles, more severe symptoms may call for one of the following treatment options:
- Anti-inflammatory medicines. Dr G may prescribe you a nonsteroidal anti-inflammatory drug if the pain you experience is not incapacitating.
- Hormone therapy. Dr G may recommend hormonal therapy to control symptoms like heavy or painful periods. The different options include intra-uterine devices which release levonorgestrel, GnRH analogues, and aromatase inhibitors. Dr G will explain the differences between these options to you at your appointment.
- Endometrial ablation. This procedure is minimally invasive and involves destroying the uterine lining. It may help reduce heavy bleeding, however some women with more advanced adenomyosis may continue to experience severe cramping pain. This is may be due to the fact that the blood in the myometrium is trapped with no way to come out when the uterine lining is destroyed. This method is often recommended to patients who do not wish to conceive in the future.
- Hysterectomy– There is no definitive cure for adenomyosis, apart from a hysterectomy (surgical removal of the uterus). However, unless your symptoms are serious or incapacitating, it’s unlikely that your case will require this form of treatment. If you warrant a hysterectomy, Dr G will perform it with a key hole approach (laparoscopic hysterectomy).
If you suspect you have adenomyosis or display any of the associated symptoms, please make an appointment with Dr G soon. With over a decade of experience treating gynaecological disorders, he will be able to diagnose your condition accurately and find you the treatment option most effective in your case,