Adenomyosis - Causes, Symptoms and Treatment

Adenomyosis is defined as the presence of endometrial glands. Approximately 80% of women with this disorder have given birth. However, the incidence of adenomyosis does not correlate with increasing number of pregnancies. Gland tissue undergoes growth during the menstrual cycle and then subsequent sloughing, the old tissue and blood cannot get out of the muscle and flow out of the cervix as part of normal menses. This trapping of the blood and tissue causes uterine pain in the form of menstrual cramps. It also produces abnormal uterine bleeding as some of the blood finally escapes the muscle and results in prolonged spotting. Approximately 60% of women with adenomyosis experience abnormal uterine bleeding which usually manifests as either hypermenorrhea (prolonged and/or profuse uterine bleeding, also called menorrhagia) or metrorragia (irregular, acyclic bleeding). Adenomyosis most commonly affects women between the ages of 40 and 50 years and is associated with a past history of childbirth. Symptoms of adenomyosis include abnormal uterine bleeding and pelvic pain.

The symptoms of these associated conditions often obscure the diagnosis of adenomyosis Dysmenorrhea (pelvic pain during menstruation) is the second most common symptom in patients with adenomyosis, occurring in 25% of cases. Adenomyosis isn't the same as endometriosis, a condition in which the uterine lining becomes implanted outside the uterus. Although the cause of adenomyosis remains unknown, the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, there are treatments that can help, but hysterectomy is the only cure. Adenomyosis is also associated with other uterine disorders. More than 80% of women with adenomyosis have another pathologic process in the uterus; 50% of patients have associated fibroids (benign smooth muscle tumors of the uterus), approximately 11% have endometriosis (endometrial tissue outside of the uterus, most commonly in the ovaries), and 7% have endometrial polyps (benign outgrowths of endometrial tissue).

Causes of Adenomyosis

Common causes of Adenomyosis

• Direct invasion of endometrial cells into the uterine walls.
• Caesarean section.
• Tubal ligation.
• Pregnancy termination.
• Inflammation.

Symptoms of Adenomyosis

Common Symptoms of Adenomyosis

• Heavy or prolonged menstrual bleeding.
• Painful periods (dysmenorrhea).
• Cramps.
• Increasingly worse.

Treatment of Adenomyosis

Common Treatment of Adenomyosis

• Treatment options range from use of NSAIDS & hormonal suppression for symptomatic relief, to endometrial ablation or hysterectomy for a more or less permanent cure
• Hysteroscopic endometrial ablation can be a treatment for adenomyosis.
• Avoiding products with xenoestrogens and/or recommend taking natural progesterone supplements.
• Endometrial ablation should be considered as a treatment.