Adenomyosis

Adenomyosis is a condition related to the uterus. In adenomyosis the cell of inner lining of the uterus (the endometrium) breaks through and enters the muscle wall of the uterus (the myometrium). This makes the muscle wall of the uterus to become thick and the whole uterus becomes bulky. Sometimes your uterus can become double or triple in size. On an average one in 10 women will have this condition. It can appear at various age groups of women who are still menstruating, but commonly seen between 40-50 years. Adenomyosis usually disappears once you attain menopause.

What are the causes?

We do not know what the cause of adenomyosis is, but is associated with increased level of hormone called estrogen and also in those women who have had many children, undergone uterine surgeries such as cesarean section or surgery to remove fibroids (myomectomy). Adenomyosis is a benign (non-cancerous) condition.

What Are the Symptoms of Adenomyosis?

Some women with adenomyosis may not have any symptoms.

Symptoms can vary from person to person. The most common symptoms would be:

  • Heavy and prolonged menstrual bleeding (may also be passing big blood clots)
  • Spotting of blood from vagina in between your periods
  • Pain during sexual intercourse (this is because the uterus has become bulky)
  • Severe cramps or sharp pain during periods
  • Lower tummy feels tender even on normal days.
  • Sometimes adenomyosis may interfere with conception (can cause infertility)
  • Due to excessive bleeding you can develop anemia (low hemoglobin) and this in turn will lead to tiredness and dizziness
  • Sometimes when the uterus becomes really bulky, you can have pressure symptoms such as heaviness in lower tummy, increase in frequency of passing urine, incomplete or pressure while passing stools
What tests will be required for diagnosis?
  • 1- Physical examination:
    • Your doctor will need to do a thorough physical examination, which includes feeling your tummy and an internal examination to check if your uterus is bulky. An internal examination will be required to ensure that there are no other conditions which could be leading to your symptoms (such as cancer of the womb, vagina and cervix), hence a through physical examination is important. If your doctor just asks for ultrasound or MRI without doing physical examination then change your doctor
  • 2- Ultrasound:
    • An ultrasound will help your doctor to make a proper diagnosis of the condition. An ultrasound will not only help to make diagnosis of adenomyosis but also it helps to rule out any possibility of tumor in the uterus.
    • There are two ways of doing ultrasound, one by placing the ultrasound probe on tummy (called trans-abdominal) and other by placing ultrasound probe in the vagina (called trans-vaginal).
  • 3- MRI (Magnetic Resonance Imaging):

Sometimes you may have to undergo MRI to know the exact cause for your symptoms and MRI is superior in diagnosing adenomyosis.

What are the treatment options available?

It is important to remember that adenomyosis is difficult to treat with medications. Adenomyosis will disappear after you attain menopause, hence treatment will depend on your age and severity of symptoms.

Treatment options available:

  • Medical Management:
    1. Anti-inflammatory Medications: your doctor may recommend anti-inflammatory drugs to control your sever menstrual pain and to reduce menstrual bleeding.
    2. Hormone Medications: sometimes you may be advised to take hormonal medications such as birth control pills (which has combination of hormones such as oestrogen and progesterone). You may be advised to use hormone (progesterone) containing intra-uterine devise, this looks like loop / copper-T, these may provide some relief. You need to remember that hormone medications may be of very small help.
  • Non-Surgical Management:
    1. HIFU: high intensity focused ultrasound. This is a non-invasive local thermal ablation technique, which has been used in the treatment of adenomyosis. Advantages of HIFU in adenomyosis:
      1. This is a non-invasive procedure. It is not like surgery where your tummy will be cut, but here the ultrasound waves are focused and the temperature at this point increases and destroys the abnormal cells, which later the body absorbs.
      2. It will not harm the surrounding normal uterine tissue.
      3. Since it is not surgery, you will recover faster and return to your work the very next day
      4. Since HIFU removes only abnormal area of adenomyosis, this will preserve your fertility and you may have chance to conceive and have normal pregnancy.
  • Surgical Management

    If medical management fails to control your symptoms and your quality of life is disturbed, then your doctor may advise surgery.

    1. Adenomyomectomy: to remove only adenomyosis and retain the uterus this is called adenomyomectomy. This surgery will be offered to those women who wish to retain their uterus for further childbearing.
    2. Hysterectomy: If you have finished your family then your doctor may offer to remove whole uterus and cervix. Removing ovaries is not required to control your adenomyosis. Ovaries need to be removed or not will be discussed with you depending at what stage of life you are in.
Does Adenomyosis Cause Infertility?
  • Yes sometimes adenomyosis may cause infertility.
What can I do to help myself?
  • Alternative therapies such as yoga and meditation may help you to ease your pain in addition to medications.