Uterine adenomyosis: definition, symptoms, treatments

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

What is adenomyosis?

Adenomyosis is a form ofendometriosis inside 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 pathology, and fortunately benign. In the sense that it is not life-threatening. On the other hand, there are certain forms which can be so painful as to handicap the daily lives of women who suffer from them.

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

  • diffuse, i.e. numerous foci scattered throughout the 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, they do have some points in common, in terms of 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 cells, butoutside 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 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 2 out of 3 cases are asymptomatic. But when it is not, these symptoms are present:
  • Menorrhagia: very heavy, long periods lasting more than 7 days, when patients lose a lot of blood. Women with adenomyosis suffer from menorrhagia in 50% of cases.
  • Dysmenorrhoea: painful menstruation, estimated to affect 30% of patients.
  • Metrorrhagia: blood loss 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 through 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 can also 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.
Indeed, many women discover they have adenomyosis when they are trying to get pregnant.

What are the treatments for adenomyosis?

Treatments can only alleviate symptoms; there is no cure today. It is advisable to consult the medical profession, your GP or healthcare professional, to assess the treatment options available.

Hormonal or drug treatment

Hormonal treatment is aimed at blocking ovulation and suppressing menstruation 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 please 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 the case of diffuse adenomyosis, in utero progestins or Gn-RH agonists may be used.

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 embryo implantation. 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 increases the chances of becoming 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. Every woman and every 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 causes 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 mucosa directly into the myometrium. It's an endometriosis inside the uterus.

Can adenomyosis disappear?

There are ways of reducing symptoms, such as oral contraceptives, medication or surgery. These different treatments 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. In fact, 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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