Uterine adenomyosis is a condition where the uterine lining grows into the muscle walls of a woman’s uterus. This can lead to heavy menstrual periods, pelvic pain, discomfort during sex, and other symptoms.

The condition is typically found in women between the ages of 35 and 50 but can also affect younger women. Patients with adenomyosis often present with painful menses (dysmenorrhea), profuse menses (menorrhagia), or both. Other possible symptoms include pain during sexual intercourse, chronic pelvic pain, and irritation of the urinary bladder.

Dr. Sermed Mezher, a London-based healthcare physician, recently discussed adenomyosis and its impact on patients. He highlighted the case of Naga Munchetty, a UK television presenter, who experienced delayed diagnosis despite multiple hospital visits. It was only through a private consultation that she was diagnosed and able to proceed with treatment. This case underscores the need for greater awareness of this condition.

Causes

The exact cause of adenomyosis is unknown, but several theories exist:

Invasive Tissue Growth: Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls. Uterine incisions made during operations, such as a cesarean section (C-section), might promote this invasion.

Developmental Origins: Other experts suspect that endometrial tissue is deposited in the uterine muscle during fetal development.

Uterine Inflammation Related to Childbirth: 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 might invade the uterine muscle, causing adenomyosis.

Regardless of how adenomyosis develops, its growth depends on the body’s circulating estrogen.

Diagnosing Adenomyosis

Adenomyosis can be difficult to diagnose because its symptoms are similar to those of other conditions, such as endometriosis and uterine fibroids. To identify the cause of your symptoms, a doctor may suggest:

Pelvic Exam: The doctor may find that your uterus is enlarged, soft, and painful to the touch if you have adenomyosis.

Ultrasound: This test allows a doctor to view the uterus, its lining, and its muscular wall. While ultrasound cannot definitively diagnose adenomyosis, it can help rule out other conditions.

Sonohysterography: In this test, a saline solution is injected through a tiny tube into the uterus while an ultrasound is performed.

MRI: An MRI can reveal if the uterus is enlarged and thickened in some areas, aiding in the diagnosis of adenomyosis.

Treatment

Adenomyosis often resolves after menopause, so treatment may depend on how close you are to that stage of life. Treatment options include:

Anti-Inflammatory Drugs (NSAIDs): Doctors might recommend anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, etc.), to manage pain. Starting these medications one to two days before your period begins and continuing during your period can reduce menstrual blood flow and relieve pain.

Hormone Medications: Combined estrogen-progestin birth control pills, hormone-containing patches, or vaginal rings might lessen heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device or continuous-use birth control pills, can cause amenorrhea (absence of menstrual periods), which may provide relief.

Hysterectomy: If pain is severe and other treatments have not been effective, a doctor might recommend surgery to remove the uterus. Removing the ovaries is not necessary to control adenomyosis.

References:

1. Fraser, Ian S., et al. "Adenomyosis and Abnormal Uterine Bleeding (AUB-A)—Pathogenesis, Diagnosis, and Management." Best Practice & Research Clinical Obstetrics & Gynaecology 51 (2018): 86–98. Accessed December 28, 2024. https://pubmed.ncbi.nlm.nih.gov/30969690/.

2. Bergeron, Christophe, Susan Amant, and Ignace Vergote. "Adenomyosis: Clinical and Imaging Aspects." Clinical Obstetrics and Gynecology 49, no. 4 (2006): 765–801. Accessed December 28, 2024. https://pubmed.ncbi.nlm.nih.gov/26049940/.

3. Dueholm, Morten, et al. "Revised Terminology and Diagnostic Criteria for Imaging in Adenomyosis." Journal of Minimally Invasive Gynecology 27, no. 4 (2020): 645–654. Accessed December 28, 2024. https://www.jmig.org/article/S1553-4650(15)01559-9/abstract.

4. Brosens, I. A. "Endometriosis and Adenomyosis: Common Etiological Pathways." Human Reproduction Update 6, no. 2 (2000): 187–194. Accessed December 28, 2024. https://linkinghub.elsevier.com/retrieve/pii/S0889854502000530.

5. Mayo Clinic. "Adenomyosis: Symptoms & Causes." Mayo Clinic. Accessed December 28, 2024. https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138.

By Priyanka S