What is Adenomyosis?
Adenomyosis is a chronic condition that affects the female reproductive system. In adenomyosis, tissue similar to the lining of the uterus (endometrium) grows within the muscular wall of the uterus. This misplaced tissue can cause the uterus to enlarge and lead to symptoms such as heavy or prolonged menstrual bleeding, severe cramps, and pelvic pain.
The exact cause of adenomyosis is uncertain, but several theories exist, including invasive growth of endometrial tissue into the uterine muscle, hormonal influences, or genetic predisposition.
Symptoms of Adenomyosis
- Heavy or prolonged menstrual bleeding
- Severe menstrual cramps (dysmenorrhea)
- Chronic pelvic pain or discomfort
- Painful intercourse (dyspareunia)
- A feeling of pressure or bloating in the lower abdomen
- Fatigue or anemia due to excessive blood loss during menstruation
Diagnosis
Adenomyosis is diagnosed through a combination of clinical evaluation and imaging techniques.
Diagnosis methods include:
- Pelvic Examination: A doctor may detect an enlarged or tender uterus during a physical exam.
- Specialised Ultrasound (USS): Transvaginal ultrasound can help identify thickened areas of the uterine wall, which may indicate adenomyosis.
- MRI: Magnetic Resonance Imaging provides detailed images of the uterus and can help confirm the diagnosis by revealing characteristic features of adenomyosis.
Unlike endometriosis, adenomyosis is typically diagnosed without the need for surgical procedures, as imaging techniques are often sufficient. However, a definitive diagnosis can sometimes only be made after a hysterectomy when the uterine tissue is examined under a microscope.
Types of Adenomyosis
Adenomyosis can be classified based on the location and extent of the endometrial-like tissue within the uterine wall. The primary types include:
- Diffuse Adenomyosis: This is the most common form, where the endometrial tissue spreads uniformly throughout the uterine muscle (myometrium), causing generalised thickening and enlargement of the uterus.
- Focal Adenomyosis (Adenomyoma): In this type, the endometrial tissue is concentrated in a specific area of the uterus, forming a localised mass called an adenomyoma. These can sometimes be mistaken for fibroids due to their similar appearance.
- Cystic Adenomyosis: A rare form of adenomyosis, where fluid-filled cystic spaces develop within the uterine muscle. This type is more commonly seen in younger women and may cause severe pain.
Severity of Adenomyosis
While adenomyosis is not typically staged like endometriosis, its severity can vary based on:
- Extent of Uterine Involvement: Diffuse cases with widespread tissue infiltration are generally more severe than focal adenomyosis.
- Depth of Invasion: The deeper the endometrial tissue penetrates into the myometrium, the more severe the condition and symptoms may be.
- Uterine Size and Symptoms: Significant uterine enlargement and debilitating symptoms, such as heavy bleeding and chronic pain, may indicate a more advanced condition.
It’s important to note that the severity of adenomyosis does not always correlate with symptom intensity. Some women with extensive adenomyosis may experience mild discomfort, while others with less tissue involvement may have severe symptoms.
Treatment
While no definitive cure exists, various management options can alleviate symptoms and improve quality of life:
Pain Medication
Over-the-counter or prescribed pain relievers such as ibuprofen or naproxen can help manage mild to moderate pain associated with adenomyosis. For more severe pain, stronger medications might be recommended by your healthcare provider.
Hormonal Therapy
Hormonal treatments aim to reduce or eliminate menstruation, thereby decreasing the growth of the endometrial-like tissue within the uterine wall. Common hormonal therapies include:
- Birth Control Pills: Help regulate menstrual cycles and reduce menstrual flow.
- Progesterone-Only Contraceptives: Such as the mini-pill, injections, or implants.
- Gonadotrophin-Releasing Hormone (GnRH) Agonists: Induce a temporary menopause, reducing estrogen levels and shrinking adenomyotic tissue.
- Levonorgestrel-Releasing Intrauterine Devices (IUDs): Provide localised hormone delivery to reduce menstrual bleeding and pain.
Surgical Treatment of Adenomyosis
Dr. Farag and the Coastal Women’s Health team specialise in diagnosing and treating adenomyosis, focusing on managing pain and improving quality of life. Surgical options may include:
- Endometrial Ablation: A procedure that destroys the lining of the uterus to reduce menstrual flow and pain.
- Uterine Artery Embolisation (UAE): Minimises blood flow to the affected areas, reducing the size of adenomyotic tissue.
- Hysterectomy: The complete removal of the uterus, considered a definitive cure for adenomyosis, typically recommended for women who have completed their families and have severe symptoms.
Additional Management Strategies
- Physical Therapy: Can help alleviate pelvic pain and improve overall pelvic floor function.
- Lifestyle Modifications: Regular exercise, a balanced diet, and stress management techniques may help reduce symptom severity.
- Alternative Therapies: Acupuncture and other complementary treatments may provide additional relief for some women.
Managing adenomyosis involves a personalised approach tailored to each individual’s symptoms, reproductive plans, and overall health. If you’re experiencing symptoms of adenomyosis, consult with Dr. Farag and the Coastal Women’s Health team to explore the most effective treatment options for your situation.