Uterine adenomyosis: definition, symptoms, treatments

You probably know about endometriosis, but do you know about adenomyosis? This disease is an extremely painful and disabling form of endometriosis for women who suffer from it, even though it is a benign pathology (not life-threatening).

What is adenomyosis?

Adenomyosis is defined as a form ofendometriosis inside the uterus. It is due to a malformation of the junction zone between the mucous membrane that lines the uterus (the endometrium) and the muscle of the uterine wall (the myometrium). This will cause infiltration of endometrial cells into the endometrium, which thickens the volume of the uterus. The infiltration can be slight or deep (therefore more painful). This condition affects about 11-13% of women of childbearing age, usually those between 35 and 40 years old (in 25% of cases). They may suffer from both external endometriosis and adenomyosis.
This is a pathology that is quite frequent and fortunately benign. In the sense that it is not life threatening for the person suffering from it. On the other hand, there are certain forms that can be very painful to the point of handicapping the daily life of women who suffer from it.
This condition related to gynecology can take several forms. It can be:
diffuse, that is to say that there will be numerous foci scattered over the entire myometrium. This is the most severe type and the most difficult to treat.
focal, i.e. there are only a few foci, located in a specific part of the uterus
external, when it is the deep pelvic endometriosis that migrates into the myometrium

What are the differences between endometriosis and adenomyosis?

Even though in many cases the two are linked, they have points in common in terms of symptoms and the fact that this disease is the result of a migration of endometrial cells to other parts of the body.

Endometriosis is ectopic

It is characterized by a migration of endometrial cellsoutside the uterus: to the bladder, the utero-sacral ligaments, the ovaries, the rectum and many other parts of the body.

Adenomyosis is intrauterine

Adenomyosis is the result of endometrial cells migrating directly into the uterine muscle tissue, creating lesions.

What causes uterine adenomyosis?

The exact causes of its development are not yet known. The disease is found in women who have had several pregnancies, or in those who have a highly developed endometrium (endometrial hyperplasia). It is not possible today to establish a link between surgery or caesarean sections and the occurrence of adenomyosis. However, there is a link between this gynecological condition and certain patients who have had placental anomalies. The use of an IUD is not associated with adenomyosis.

What are the symptoms of adenomyosis?

It is estimated that in 2 cases out of 3, it is asymptomatic. But when it is not, we find these symptoms there:
  • Menorrhagia: These are very heavy and long periods that last more than 7 days, where patients lose a lot of blood. Women with adenomyosis suffer from menorrhagia in 50% of cases.
  • Dysmenorrhea: painful menstruation, which is estimated to affect 30% of patients with adenomyosis.
  • Metrorrhagia, which is blood loss outside the menstrual flow. They occur in 20% of cases.
  • Pain during sexual intercourse(dyspareunia)
  • A feeling of heaviness in the lower abdomen

How is adenomyosis diagnosed?

The diagnosis is made by imaging tests, after a clinical examination by your gynecologist. In addition, we are now able to determine the depth of damage and the presence and location of cells that have migrated. There are several techniques:
  • Ultrasound can show if the uterus is larger in size, if it has asymmetrical walls, if the myometrium is inflamed and thickened. It should be done in the second half of the cycle. An endovaginal examination (by inserting a vaginal probe) is more precise and is often performed. This will also allow the detection of any associated pathologies (uterine fibroid etc...)
  • Pelvic MRI is the second-line examination. It is performed outside the cycle to complete the diagnosis.
  • Hysteroscopy or hysterosalpingography do not really have any added value, except in the case of an infertility or fertility assessment.
Many women discover that they have adenomyosis when they try to get pregnant.

What are the treatments for adenomyosis?

Treatments can only relieve the symptoms; there is no treatment that can completely cure the disease. It is advisable to consult with your doctor or health care professional to evaluate the treatments available.

Hormonal or medicinal treatment

Hormonal treatment aims to block ovulation and suppress menstruation to reduce pain and symptoms.

An adapted contraception such as the continuous pill which will stop menstruation allows the endometrium to atrophy. The same applies to the hormonal IUD, but be careful, the hormonal IUD is only useful in the case of adenomyosis, not external endometriosis. In fact, it can only be treated with an oral contraceptive that will block the functioning of the ovaries.

The results of the medical treatment are very variable, since bleeding and pain persist despite the treatment being taken properly. They are also considered in the event of a planned pregnancy.

It is possible to take progestins in utero or Gn-RH agonists in case of diffuse adenomyosis.

Surgical treatment

There are also surgical treatments. In the most extreme stages,hysterectomy, i.e. removal of the uterus, can be considered. This is a radical treatment with possible complications and for those who no longer wish to become pregnant. However, this surgical operation is only performed if the disease causes intense pain and very significant bleeding. However, if endometriosis is associated, a hysterectomy will unfortunately not be sufficient.

Are adenomyosis and infertility related?

In the case of a severe stage, this pathology can indeed prevent the implantation of the embryo. In fact, it is the inflammatory reaction and the thickening of the junction zone between the endometrium and the myometrium that will prevent the embryo from implanting.
In addition, the risk of miscarriage in an affected woman is doubled.
An MRI scan during the MAP (medically assisted reproduction) assessment can show the thickness of the junction zone between the endometrium and the uterine muscle tissue. Thickening is an indicator of a decrease in the success rate of embryo implantation.
Therefore, medication with GnRH analogues taken for 3 to 6 months increases the chances of getting pregnant.

Is it possible to suffer from adenomyosis and endometriosis?

In 6 to 20% of cases, the two are linked. It is quite possible to suffer from both at the same time. But a woman can have adenomyosis without endometriosis and vice versa. Each woman and each degree of damage is different, and this is what complicates the diagnosis.

FAQs on adenomyosis

Why does adenomyosis hurt?

The migration of uterine lining cells within the uterine muscle tissue causes pain, especially during menstruation, since these uterine cells are under hormonal influence, and hormones fluctuate during the cycle.

Is adenomyosis a cancer?

No, it is not cancer! It is a gynecological pathology that is characterized by a migration of uterine mucosa directly into the myometrium. It is an endometriosis inside the uterus.

Can adenomyosis disappear?

There are solutions to reduce the symptoms, such as taking oral contraceptives, drug treatments or surgery. These different treatments reduce the symptoms, but do not cure it permanently.

How can Adenomyosis be treated naturally?

When suffering from this condition, external factors can play a key role in relieving pain and symptoms. One such factor is diet. Indeed, adopting a non-inflammatory diet helps to calm the inflammation of endometrial cells, which are under the influence of the cycle and hormones.

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