Top 10 Facts about Adenomyosis

What is adenomyosis?

Adenomyosis is defined as the presence of endometrial tissue, which normally lines the uterus, which has grown into the muscular wall of the uterus. It can be diffuse or localized (focal) and the lesions can be solid or cystic.

Is it the same as endometriosis?

Adenomyosis differs from endometriosis — a condition in which the uterine lining becomes implanted outside the uterus — although women with adenomyosis often also have endometriosis.

In endometriosis, the “functional” part of the uterine lining is implanted – these implants respond to the (monthly) cyclical changes in your hormone levels. In adenomyosis the “basal” layer of the uterine lining grows within the uterine musculature. The basal lining is NOT responsive to cyclical changes in your hormone levels. The cause of adenomyosis remains unknown, but the disease typically disappears after menopause.

1. What is adenomyosis?

   Adenomyosis is defined as the presence of endometrial tissue, which normally lines the uterus, which has grown into the muscular wall of the uterus. It can be diffuse or localized (focal) and the lesions can be solid or cystic.

2. Is it the same as endometriosis?

   Adenomyosis differs from endometriosis — a condition in which the uterine lining becomes implanted outside the uterus — although women with adenomyosis often also have endometriosis.

   In endometriosis, the “functional” part of the uterine lining is implanted – these implants respond to the (monthly) cyclical changes in your hormone levels. In adenomyosis the “basal” layer of the uterine lining grows within the uterine musculature. The basal lining is NOT responsive to cyclical changes in your hormone levels. The cause of adenomyosis remains unknown, but the disease typically disappears after menopause.

3. What are the symptoms of adenomyosis?

   Adenomyosis can sometimes be without any signs or symptoms. In other cases, adenomyosis may cause:

   
   • Heavy or prolonged menstrual bleeding.
   • Severe cramping or sharp, knife-like pelvic pain during menstruation (dysmenorrhea).
   • Menstrual cramps that last throughout your period and worsen as you get older.
   • Pain during intercourse.
   • Bleeding between periods.
   • Passing blood clots during your period

   Your uterus may double or triple in size. Although you might not know if your uterus is enlarged, you may notice that your lower abdomen seems bigger or feels tender.

   Any and all of these symptoms can contribute towards lowering your quality of life;

4. What is the cause of adenomyosis?

   The cause of adenomyosis isn’t known. Expert theories about a possible cause include:

   • Invasive tissue growth. Some experts believe that adenomyosis results from the direct invasion of endometrial cells from the surface of the uterus into the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) may promote the direct invasion of the endometrial cells into the wall of the uterus.
   • Developmental origins. Other experts speculate that adenomyosis originates within the uterine muscle from endometrial tissue deposited there when the uterus first formed in the female fetus.
   • Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. An inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
   • Stem cell origins. A recent theory proposes that bone marrow stem cells may invade the uterine muscle, causing adenomyosis.

   Regardless of how adenomyosis develops, its growth depends on the circulating estrogen in a woman’s body. When estrogen production decreases at menopause, adenomyosis eventually goes away.

5. What are the risk factors for adenomyosis?

   Adenomyosis is increased after uterine surgery (e.g. removal of fibroids), cesarean delivery, infections after delivery (post partum endometritis), pregnancy, other uterine manipulations (D&C, endometrial ablation).

6. How is adenomyosis diagnosed?

   Your doctor may suspect adenomyosis based on:

   • Signs and symptoms
   • A pelvic exam that reveals an enlarged, tender uterus
   • Ultrasound imaging of the uterus. This is the commonest technique used to diagnose adenomyosis. However, in situations where the diagnosis is unclear, a MRI may be required.
   • Magnetic resonance imaging (MRI) of the uterus (see picture below)

   

   In some instances, your doctor may biopsy a small piece of your uterine lining to rule out cancer. However, such a biopsy won’t help your doctor confirm a diagnosis of adenomyosis. The only way to be certain of adenomyosis is to examine uterine tissue using a microscope after removal of the uterus (hysterectomy).

7. What are the conditions that can mimic adenomyosis?

   Many women have other uterine diseases that cause signs and symptoms similar to adenomyosis, making adenomyosis more difficult to diagnose. Such conditions include fibroid tumors (leiomyomas), uterine cells growing outside the uterus (endometriosis) and growths in the uterine lining (endometrial polyps). Your doctor may diagnose adenomyosis only after he or she determines there are no other causes for your signs and symptoms.

8. Does adenomyosis cause infertility?

   There is no definite established causal relationship between adenomyosis and infertility. A recent publication in the journal Human Reproduction (Vercellini et al. Vol.29, No.5 pp. 964–977, 2014) showed a 28% reduction in IVF pregnancy rates in patients with adenomyosis. There was also an increase in the miscarriage rate and a decrease in the live birth rate.

9. What is the treatment of adenomyosis?

   The treatment is usually symptomatic. This includes the use of anti-inflammatory medications (Motrin, Advil. Ibuprofen) for symptomatic relief. Birth control pills may be prescribed to control bleeding. Use of medications to suppress the adenomyosis (GnRH agonists e.g. leuprolide acetate (Lupron) or nafarelin (Synarel)) has met with limited success.

10. Will I need a hysterectomy?

    A hysterectomy is a reasonable option for women who have completed child bearing. However, patients desiring fertility can be offered uterus-sparing surgeries. In this the adenomyosis is surgically removed and the uterus is then reconstructed. Unlike fibroids (that have a capsule and therefore can be easily shelled out), adenomyosis resection can be surgically challenging.