Obstetrics And Gynaecology
Adenomyosis occurs when tissue from the lining of your uterus grows into your uterine wall. It can cause your uterus to double or triple in size. Symptoms include heavy periods, cramping and painful sex. It’s typically treated with medication or surgery.
What Is Adenomyosis?
Adenomyosis (pronounced “add-en-o-my-OH-sis”) is when tissue similar to the lining of your uterus (endometrium) starts to grow into the muscle wall of your uterus (myometrium). It causes your uterus to thicken and enlarge — sometimes, up to double or triple its usual size. Adenomyosis can cause painful periods, heavy or prolonged menstrual bleeding with clotting and abdominal/pelvic pain.
How common is adenomyosis?
Many women and people assigned female at birth (AFAB) aren’t aware they have adenomyosis because the condition doesn’t always cause symptoms. The exact prevalence of adenomyosis is unknown. However, researchers know it’s more common in people who:
- Have had a procedure on their uterus.
- Are older than 40.
Approximately 2% to 5% of adolescents with severely painful cycles have adenomyosis.
What are the signs of adenomyosis?
About 1 in 3 people with adenomyosis don’t have signs or symptoms.
- Painful menstrual cramps (dysmenorrhea).
- Heavy menstrual bleeding (menorrhagia).
- Abnormal menstruation.
- Pelvic pain with or without severe cramping.
- Painful intercourse (dyspareunia).
- Infertility.
- Enlarged uterus.
- Bloating or fullness in your belly (adenomyosis belly).
What causes adenomyosis?
Researchers don’t know why some people develop adenomyosis or what causes it. However, some research suggests hormones, genetics or inflammation/trauma may contribute to adenomyosis.
What are the risk factors for this condition?
Adenomyosis most commonly occurs in women and people AFAB who:
• Are between the ages of 40 and 50.
• Have given birth at least once.
• Have had prior uterine surgeries such as uterine fibroid removal or dilation and curettage (D&C).
• Have endometriosis.
However, providers are diagnosing adenomyosis more frequently in people in their 30s who have abnormal vaginal bleeding or painful periods.
What are the complications of adenomyosis?
The symptoms of adenomyosis tend to get worse over time. Heavy menstrual bleeding from adenomyosis increases your risk of anemia. Anemia occurs when your body doesn’t have enough iron-rich red blood cells. Anemia may cause you to feel fatigued or cold.
Can adenomyosis become cancerous?
No. Adenomyosis itself doesn’t cause cancer or lead to cancer.
How is adenomyosis diagnosed?
Healthcare providers often suspect adenomyosis based on your symptoms and one or more of these tests:
- Pelvic exam: During a pelvic exam, your provider may notice that your uterus has gotten larger, softer or painful to the touch.
- Ultrasound: A transvaginal ultrasound uses sound waves to produce images of your pelvic organs. These images can sometimes show the thickening of your uterine wall.
- Imaging scans: Magnetic resonance imaging (MRI) scans can show uterine enlargement and thickening of certain areas of your uterus.
How is adenomyosis managed or treated?
Because the hormone estrogen promotes endometrial tissue growth, adenomyosis symptoms often go away after menopause. In the meantime, these treatments can ease pain, and help with heavy bleeding and other symptoms:
- Pain medications: Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®), ease cramping.
- Hormonal medications: Certain hormonal medications can help with menstruation and abnormal bleeding. Options include birth control pills, Depo-Provera® injection and hormonal intrauterine devices (IUD), such as Mirena®.
- Nonhormonal medication: Medications like tranexamic acid can reduce the amount of vaginal bleeding.
- Adenomyomectomy: Surgery to remove adenomyosis from your uterine muscle. This procedure is similar to a myomectomy, which removes uterine fibroids.
- Hysterectomy: This surgery removes your uterus. After a hysterectomy, you won’t have a menstrual cycle or be able to get pregnant.
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What happens if adenomyosis is left untreated?
Left untreated, adenomyosis can lead to infertility or miscarriage. This is because the embryo can’t implant into your uterine lining. Other problems may include chronic pelvic and abdominal pain.
How does adenomyosis affect pregnancy?
Adenomyosis tends to affect women who have had at least one child. However, the condition may make it difficult to conceive for the first time or to have another child. Once you’re pregnant, there’s an increased risk of:
• Miscarriage.
• Premature labor.
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