Adenomyosis is a chronic condition that affects the uterus and causes symptoms such as irregular and heavy menstrual bleeding and pelvic pain. Despite affecting as many as one in five women, it is still relatively unheard of. This article aims to shed light on the condition and provide information on its causes, diagnosis, and treatment.
What is Adenomyosis?
There are two key layers in the uterus: the endometrium and the myometrium. In people with adenomyosis, endometrium-like cells are found in the wrong place – the myometrium. Although a large number of women with adenomyosis have endometriosis as well, adenomyosis is a distinct disease from endometriosis. In endometriosis, endometrium-like cells are also found in the wrong place, but in this case outside of the uterus, mainly in the pelvic cavity.
Diagnosis and Treatment
Adenomyosis is a difficult condition to diagnose. Historically, the presence of endometrium-like cells in the myometrium could only be verified by pathology assessment where the myometrium is examined under a microscope after a hysterectomy (surgery to remove the uterus). Recent years have seen increased diagnoses with the development of imaging technologies such as MRI and detailed pelvic ultrasound.
Although adenomyosis is now commonly identified without the need for a hysterectomy, doctors are still working towards developing a standardized method for non-surgical diagnosis. As a result, it remains uncertain exactly how many women have adenomyosis.
Treatment strategies include hormonal medications such as oral contraceptives, progesterone-containing pills, the insertion of a progesterone-releasing coil (for example, Mirena), or a drug called GnRHa that stops the natural production of sex hormones. Non-hormonal treatments include tranexamic acid. These treatments aim to minimize menstrual bleeding. Pain is often treated with non-steroidal anti-inflammatory drugs.
Treatments that work for some women don’t for others, adding weight to the argument that there’s more than one type of adenomyosis. Treatment strategies should be tailored to patients, depending on their fertility wishes and symptoms.
If medical treatments are not providing adequate relief from symptoms, there are surgical options, namely removal of the focal lesions or a hysterectomy.
Causes and Prevalence
We don’t yet understand why some women develop adenomyosis, though evidence shows there is an increasing prevalence with age. It is thought that the region between the endometrium and myometrium becomes damaged, either by the natural processes of the menstrual cycle, pregnancies, and childbirth, or medical procedures. In some women, damage to the endometrial tissue layer does not heal as it should, and the endometrium-like cells enter and grow abnormally into the myometrium. These disrupt the normal functions of the myometrium leading to pain and bleeding.
It’s possible that a variety of mechanisms may contribute, and that there is not one common disease-causing factor behind adenomyosis.
Symptoms and Complications
Adenomyosis can cause symptoms including irregular and heavy menstrual bleeding and pelvic pain. The severity of symptoms varies between patients – up to one-third of women with adenomyosis may have minimal or no symptoms at all. The condition can also affect fertility. Women with adenomyosis who do become pregnant have an increased risk of miscarriage, pre-term delivery, pre-eclampsia, and bleeding after delivery.
Awareness and Research
Although adenomyosis is a common disorder that affects many women, including those of reproductive age, it doesn’t receive enough clinical and research attention. There is also a lack of knowledge and awareness around adenomyosis among many healthcare professionals and the public. This needs to change so we can improve our understanding of the condition, diagnosis, and treatment options.
Scientists and doctors who specialize in adenomyosis are still on the quest to find an accurate, non-invasive diagnostic method, and hopefully, one day, a cure.
Adenomyosis is a chronic condition that affects the uterus and causes symptoms such as irregular and heavy menstrual bleeding and pelvic pain. Although it is relatively unheard of, it affects as many as one in five women. Treatment strategies include hormonal and non-hormonal medications, and surgical options are available if medical treatments do not provide adequate relief from symptoms. Scientists and doctors are still investigating the causes and prevalence of adenomyosis, and there is a lack of knowledge and awareness around the condition among many healthcare professionals and the public.