Adenomyosis: Symptoms, Diagnosis, and Treatment

 Adenomyosis is a condition that occurs when the endometrial tissue lining the uterus is present within and grows into the muscular wall of the uterus (myometrium). It may cause the uterus to thicken and enlarge, thereby resulting in abdominal or pelvic pain, prolonged menstrual bleeding, clotting, painful periods, and much more.
The exact prevalence of adenomyosis among women is unknown, but it usually resolves after menopause. Researchers state that approximately 2% to 5% of adolescents with severe painful cycles have adenomyosis.
This article will make you understand the causes and symptoms of adenomyosis and the treatment methods to cure the disease.

Symptoms of adenomyosis

Adenomyosis doesn’t always cause symptoms but can disrupt your daily life with mild discomfort. Adenomyosis can occur because of inflammation or trauma, hormonal changes, and genetics. You may feel pressure or tenderness in your lower abdomen, and your uterus gets bigger. Some generic reasons include:

• Heavy menstrual bleeding
• Chronic pelvic pain
• Severe cramping
• Bloating
• Blood clots during bleeding
• Enlarged uterus

Adenomyosis is believed to be hormone-sensitive or estrogen-dependent and may develop endometriosis if untreated.

According to a qualitative analysis of 16 research studies, 20–88.8% of women who experienced adenomyosis symptoms had the condition, with an average of 30–35%. 

Most women receive a diagnosis between 32–38 years old.

 Causes and risk factors of adenomyosis

Though the cause is unknown, there are several theories about adenomyosis, which include:

• Extra tissues in the uterine wall (present before birth and grow during adulthood)
• Inflammation in the uterine after childbirth (it breaks the usual boundaries of the cells lining the uterus)
• Invasive growth of endometrial cells
• Stem cells in the myometrium

However, being physically active can help improve blood flow, which further aids in the cure of adenomyosis. Adenomyosis, endometriosis, and uterine fibroids are similar terms that can get confused easily. All are disorders that happen in the female reproductive tract. They are different conditions that require other treatments. Here’s the fundamental difference between these 3:

• Adenomyosis is characterized by the infiltration of endometrial tissue throughout the uterine wall.
• Endometriosis refers to the endometrial tissue growth outside the uterus, potentially affecting the fallopian tubes, ovaries, vagina, or intestines.
• Uterine fibroids, conversely, are noncancerous tumours that develop in various regions of the uterus.

 Adenomyosis diagnosis

A diagnostic assessment typically involves a medical examination conducted by a physician and the use of imaging techniques. The doctor will perform a pelvic examination to ascertain whether your uterus is enlarged or sensitive to touch. 
In certain instances, individuals with adenomyosis may have a uterus that is twice or thrice the average size. Imaging procedures such as ultrasound or MRI scans may be conducted during the diagnostic evaluation.

1. Pelvic Examination

If the doctor suspects adenomyosis, the first step is the physical examination to investigate the enlargement or tenderness of the uterus.

2. Ultrasound

A transvaginal ultrasound is a quick and easy test that helps the doctor diagnose the condition and rule out other symptoms. It is performed in the doctor’s office and uses sound waves to develop moving images of your internal organs and pelvic anatomy (such as the uterus). 
Diagnosing adenomyosis with ultrasound can seem challenging; hence, your doctor may recommend more advanced imaging.

3. MRI Scan

The preferred imaging test for diagnosing adenomyosis is the MRI scan, which utilizes a combination of radio and magnet waves to generate detailed images of the internal organs.
During an MRI, specific radiologic characteristics of the uterus can indicate the presence of adenomyosis. These may include the thickening of the region between the endometrium (the lining of the uterine cavity) and the myometrium.
To undergo this procedure, one must lie still on a metal table that will smoothly slide into the scanning machine.
If you have an upcoming MRI appointment, it is crucial to inform the doctor if there is any possibility of pregnancy. Additionally, make sure to disclose any metal implants, electrical devices, piercings, or metal fragments from a gunshot wound to both the doctor and the MRI technician.

4. Sonohysterography

Another technique used to evaluate the symptoms associated with adenomyosis is sonohysterography. In sonohysterography, the doctor will inject a saline solution into the uterus through a tiny tube as an ultrasound is given.

Treating adenomyosis

People with mild forms of adenomyosis will not require any medical treatment. However, doctors may recommend treatment options only if the symptoms interfere with your daily activities. Some of the treatment options aimed at reducing the symptoms of adenomyosis include: 

1. Anti-inflammatory medications 

Anti-inflammatory medications like ibuprofen reduce blood flow during periods and relieve severe cramps. The doctor will give you advice on the frequency of taking these medications. 
One possibility involves consuming anti-inflammatory medications before 2 to 3 days of the start of your period and continuing with the medicines during your period. If you’re pregnant, consult a doctor before taking anti-inflammatory medications. Depending on the ongoing trimester, they may recommend avoiding these medications. 

2. Endometrial ablation 

Endometrial ablation involves techniques and methods to destroy or remove the endometrium. It is an outpatient procedure with a very short recovery time. But this procedure will only work for some since adenomyosis invades the muscle more deeply. It is only recommended for people who have completed childbearing or are not interested in getting pregnant.

3. Hormonal treatments 

Hormonal therapies have the potential to regulate the estrogen levels that might be exacerbating your symptoms. These therapies encompass various options such as oral contraceptives like birth control pills, gonadotropin-releasing hormone analogues like leuprolide (Lupron), and progestin-only contraceptives like an injection, a pill, or an intrauterine device (IUD). Planned Parenthood states that progestin IUDs like Skyla and Mirena can have a duration that ranges from 3 to 7 years, depending on the specific brand. 

4. Uterine artery embolization 

Uterine artery embolization prevents specific arteries from supplying blood to the affected area. The adenomyoma shrinks when the blood flow cuts off. This procedure is performed in a hospital and is typically used to treat uterine fibroids. It involves staying overnight afterwards, and it does not cause scar formation in the uterus since it is minimally invasive.

5. Ultrasound-guided focused ultrasound surgery 

Ultrasound-guided focused ultrasound surgery incorporates precisely focused high-intensity waves to destroy the targeted tissue and create heat. The heat is monitored in real-time using ultrasound images. Early studies and research have shown this procedure to be effective in relieving the symptoms of adenomyosis. 

6. Hysterectomy 

Adenomyosis can only be fully treated by undergoing a hysterectomy, which is a robust surgical procedure that involves the entire removal of the uterus. This option is typically reserved for severe cases and individuals who do not intend to have children in the future. It’s important to note that the presence of ovaries does not affect adenomyosis. Your doctor will discuss with you whether it’s necessary to remove them, particularly if you’re postmenopausal, or leave them intact for other reasons.

Potential complications of adenomyosis 

The symptoms of adenomyosis can negatively affect your lifestyle. Some people may experience pelvic pain and excessive bleeding that prevents them from enjoying their day-to-day activities. People with adenomyosis are at an increased risk of blood loss and anaemia, resulting in an iron deficiency in the body.
Without enough iron, the body fails to make enough red blood cells (RBC) that carry oxygen to the body’s tissues. This can cause dizziness, fatigue, and moodiness. Adenomyosis is also linked with depression, anxiety, and irritability.

When to speak with a doctor 

Anyone who suspects adenomyosis should talk to their doctor for evaluation. If a person is experiencing severe uterine cramping or heavy periods, they must meet their healthcare provider. The doctor must evaluate to determine the root cause, as these symptoms can trigger other severe conditions. 

Takeaway

Adenomyosis is a non-fatal condition that can cause significant discomfort and complications before menopause. While it will eventually disappear on its own, it is essential to seek medical advice if you suspect you have adenomyosis or endometriosis. There are various treatments available to help manage the symptoms.

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