What is Adenomyosis?

What is Adenomyosis?

Not because it might be less well known does not mean that adenomyosis is not important. The prevalence of this condition is between 20 to 35% (1), and it can significantly affect the quality of life of those who suffer from it. Some of the symptoms of adenomyosis are heavy or prolonged periods with the presence of blood clots, painful menstrual cramps, pain during sexual intercourse, and/or infertility (2).
Adenomyosis is defined as the growth of endometrial tissue, which is the tissue that lines the uterus, into the muscular wall of the uterus (3). This extra tissue enlarges the uterus double to triple its size, causing heavy and painful periods (4) that can even lead to chronic anemia and fatigue (3). Some risk factors for adenomyosis are having a prior uterine surgery (e.g C-section), childbirth, smoking, the use of the breast cancer drug tamoxifen, and age between 40s and 50s although it can also occur in younger women (2, 3).

What is the difference between adenomyosis and endometriosis?

Both conditions involve the growth of cells that line the uterus in other anatomical places. In the case of endometriosis, these cells grow in organs close to the uterus like ovaries, fallopian tubes, and/or bladder. On the other hand and as mentioned before, during adenomyosis, these cells grow deep only in the muscular wall of the uterus and thicken it (5).

The reason why adenomyosis occurs is still unclear. It has been suggested that it could occur due to the invasion of endometrial cells into the muscular walls through uterine incisions during operations such as cesarean section. Also, the inflammation of the uterus that occurs after having a baby can generate a rupture of the endometrial tissue and the migration of endometrial cells into the muscular walls of the uterus (3).

How is the diagnosis of adenomyosis made?

Transabdominal ultrasonography, which is commonly used to monitor a baby’s development during pregnancy, is also able to reveal uterine enlargement without any features of fibroids and asymmetric thickening of anterior and posterior muscular walls of the uterus. Moreover, magnetic resonance imagining (MRI) is also a non-invasive technique to diagnose this disease (6). The treatment of adenomyosis is going to depend on the woman’s age, reproductive status, and symptoms (6). There is no specific medication to treat adenomyosis, however, there are several hormones and non-hormonal treatments that can help treat the symptoms and to improve fertility outcomes. For example, the use of Gonadotropin-Releasing-Hormone (GnRH) seems to be beneficial for women with adenomyosis that want to increase their chances of pregnancy. On the other hand, for reducing bleeding progestins can be used (6). Only the removal of the uterus (hysterectomy) can cure adenomyosis (3).

References:

1.Gunther R, Walker C. Adenomyosis. [Updated 2021 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539868/ 2.https://www.healthline.com/health/adenomyosis#symptoms 3.https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138#dialogId13023747 4.https://my.clevelandclinic.org/health/diseases/14167-adenomyosis 5.https://www.webmd.com/women/endometriosis/women-endometriosis-vs-adenomyosis 6.Vannuccini, S., & Petraglia, F. (2019). Recent advances in understanding and managing adenomyosis. F1000Research, 8, F1000 Faculty Rev-283. https://doi.org/10.12688/f1000research.17242.1