Adenomyosis is a medical condition in which the endometrial tissue (i.e. the lining of the womb which sheds off with every cycle at menstruation) is found within the muscular wall of the uterus. This tissue within the walls of the uterus is also influenced by the female hormones, and so it thickens during the cycle and attempts to be shed when menstruation begins. This causes the uterus to become enlarged and painful, and is responsible for the painful periods that are characteristic of adenomyosis.
It is unclear what causes adenomyosis. Although some studies suggest links to childbirth, uterine surgery, and errors during development, no definite cause has been found. However, it is known that adenomyosis occurs more commonly in middle aged women and women who have had a previous uterine surgery or delivery. It is possible that the condition goes undiagnosed in younger women, as it is commonly mistaken for uterine fibroids.
The symptoms of adenomyosis include the following:
• Heavy and prolonged menstrual bleeding
• Painful menstrual periods (Dysmenorrhoea)
• Pain during intercourse
• Abdominal discomfort (bloating)
• Swelling or enlargement of the abdomen
• Pressure or fullness in the lower abdomen
A diagnosis of adenomyosis can be made with an ultrasound scan, but it is a diagnosis that is easily missed, because adenomyosis closely resembles fibroids on ultrasound scan and may be taken as such. It is not uncommon to discover during surgery for fibroids that the patient actually has adenomyosis and not fibroids. If adenomyosis is suspected from an ultrasound scan, your doctor will request for a test called an MRI – Magnetic Resonance Imaging. This is a very sensitive imaging technique which is more accurate than a conventional scan; it is more accurate in detecting adenomyosis.
Adenomyosis can be misdiagnosed as uterine fibroids or endometriosis, because they have similar symptoms.
The different treatment options for adenomyosis are as follows:
Pain medications: These are given to relieve the pain so that you can go about your regular activities. Sometimes, you may need to be on more than one pain medication at the same time, in order to achieve adequate relief.
Hormonal medications: Hormonal preparations can be given to disrupt the hormonal levels of a normal menstrual cycle, thus preventing the endometrial tissue in the uterine walls from also growing, shedding, and causing pain. This is not a permanent treatment, as normal menstruation resumes and the symptoms start again in most cases when the medication is stopped.
Abdominal debulking of adenomyosis: This is an open surgery that is performed by making a cut on the lower abdomen to expose the uterus and reduce/ remove as much of the adenomyosis that is possible without damaging the uterus. This can be done if it has been confirmed that the adenomyosis is located in a particular area of the uterus, or in cases where the adenomyosis was discovered incidentally during another uterine surgery. For this procedure, one will need to be on admission for about four days.
Hysterectomy: This is the complete removal of the uterus and is reserved for women who have completed childbearing. It can be done either by making a cut on the lower abdomen or through a laparoscopic procedure. This can be considered as a definitive treatment and ensures that the adenomyosis do not recur.