Uterine adenomyosis: definition, symptoms, treatments

You're probably familiar with endometriosis, but what about adenomyosis? Adenomyosis is an extremely painful and debilitating form of endometriosis, even though it's a benign (non-life-threatening) condition.


What is adenomyosis?

It is defined as a form ofendometriosis internal to the uterus. It is due to a malformation of the junction zone between the mucous membrane lining the uterus (the endometrium) and the muscle of the uterine wall (the myometrium). This causes infiltration of endometrial cells into the myometrium, thickening the volume of the uterus. The infiltration may be slight or deep (and therefore more painful). This condition affects around 11-13% of women of childbearing age, generally between 35 and 40 (in 25% of cases). They may suffer from both external endometriosis and adenomyosis.

It's a fairly common and fortunately benign pathology. In the sense that it is not life-threatening. On the other hand, there are certain forms which can be very painful, to the point of crippling the daily lives of women who suffer from them.

This gynecological condition can take many forms. It can be :

  • diffuse, i.e. there will be numerous foci scattered over lthe whole myometrium. This is the most severe type, and the most difficult to treat.
  • focal, i.e. there are only a few foci, localized in a specific part of the uterus
  • external, when deep pelvic endometriosis migrates into the myometrium

What are the differences between endometriosis and adenomyosis?

Although in many cases, the two are linked, and share common symptoms and the fact that this disease is the result of endometrial cells migrating to other parts of the body.

Endometriosis is extrauterine

It is characterized by the migration of endometrial cellsaway from the uterus, towards the bladder, utero-sacral ligaments, ovaries, rectum and many other parts of the body.

Adenomyosis is intrauterine

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

What causes uterine adenomyosis?

The exact causes of its development are still largely unknown. The disease is found in women who have had several pregnancies, or in those with a highly developed endometrium (endometrial hyperplasia). No link has yet been established between surgery or caesarean section and the onset of adenomyosis. However, there is a link between this gynaecological condition and certain patients who have had placental anomalies. IUD insertion is not associated with adenomyosis.

What are the symptoms of adenomyosis?

It is estimated that in 2 out of 3 casesit is asymptomatic. But when it's not l, these symptoms are present:
  • Menorrhagia: these are periods very abundant and long periods, lasting more than 7 days, during which patients lose a great deal of blood. Women with adenomyosis suffer from menorrhagia in 50% of cases.
  • Dysmenorrhea: painful menstruation, estimated to affect 30% of sufferers.
  • Metrorrhagia, which is the loss of blood outside the menstrual flow. They occur in 20% of cases.
  • Pain during intercourse(dyspareunia)
  • A feeling of heaviness in the lower abdomen

How is adenomyosis diagnosed?

Diagnosis is made using imaging tests, following a clinical examination by your gynecologist. It is now possible to determine the depth of damage and the presence and location of migrated cells. Several techniques are available:
  • Ultrasound can show whether the uterus is larger in size, has asymmetrical walls, or whether the myometrium is inflamed and thickened. It should be performed in the second half of the cycle. An endovaginal examination (by insertion of a vaginal probe) is more precise, and is often performed. It will also help detect any associated pathologies (uterine fibroids, etc.).
  • Pelvic MRI is the second-line examination. It is performed outside the cycle, to complete the diagnosis.
  • Hysteroscopy or hysterosalpingography have no real added value, except in the case of an infertility or fertility assessment.
In fact, many women discover they have adenomyosis when they try to get pregnant.

How is adenomyosis treated?

Treatments can only relieve symptoms, and there is no cure today. It is advisable to consult the medical profession, your GP or your health care professional, to evaluate treatment options.

Hormonal or drug treatment

Hormonal treatment is aimed at blocking ovulation and suppressing periods to reduce pain and symptoms.

Appropriate contraception such as the continuous pill, which stops menstruation, atrophies the endometrium. The same applies to the hormonal IUD, but note that the hormonal IUD is only useful in cases of adenomyosis, not external endometriosis. This can only be treated with an oral contraceptive, which blocks the functioning of the ovaries.

Drug treatment has very variable results, with bleeding and pain persisting despite proper treatment. They are also considered when pregnancy is planned.

In utero progestins or Gn-RH agonists can be taken in cases of diffuse adenomyosis.

Surgical treatment

Surgical treatment is also available. In the most extreme stages,hysterectomy, i.e. removal of the uterus, may 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 heavy bleeding. But if endometriosis is also present, hysterectomy will unfortunately not be sufficient.

Are adenomyosis and infertility linked?

In severe cases, this pathology can prevent the embryo from implanting. In fact, it is the inflammatory reaction and thickening of the junction zone between the endometrium and myometrium that will prevent the embryo from implanting.
Furthermore, the risk of miscarriage in an affected woman is doubled.
An MRI scan performed during a PMA (medically assisted reproduction) assessment shows the thickness of the junction between the endometrium and uterine muscle tissue. Thickening is an indicator of the reduced success rate of embryo implantation.
In this case, treatment with Gn-RH analogues taken over a period of 3 to 6 months improves 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 involvement is different, and this is what complicates the diagnosis.

Adenomyosis FAQ

Why does adenomyosis hurt?

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

Is adenomyosis cancer?

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

Can adenomyosis disappear?

There are ways of reducing symptoms, such as oral contraceptives, drug treatments or surgery. These different treatments help to reduce symptoms, but do not provide a permanent cure.

How can adenomyosis be treated naturally?

When suffering from this pathology, external factors can play key roles 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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