Adenomyosis

Adenomyosis

Definition:

Adenomyosis (ad-uh-no-my-O-sis) occurs when endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus. This happens most often late in your childbearing years after having children.

Adenomyosis differs from endometriosis — a condition in which the uterine lining becomes implanted outside the uterus — although women with adenomyosis often also have endometriosis. The cause of adenomyosis remains unknown, but the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, certain treatments can help, but hysterectomy is the only cure.

Symptoms:

Sometimes, adenomyosis is silent — causing no signs or symptoms — or only mildly uncomfortable. In other cases, adenomyosis may cause:

• Heavy or prolonged menstrual bleeding
• Severe cramping or sharp, knife-like pelvic pain during menstruation (dysmenorrhea)
• Menstrual cramps that last throughout your period and worsen as you get older
• Pain during intercourse
• Bleeding between periods
• Passing blood clots during your period

Your uterus may double or triple in size. Although you might not know if your uterus is enlarged, you may notice that your lower abdomen seems bigger or feels tender.
When to see a doctor
If you experience any signs or symptoms of adenomyosis, such as prolonged, heavy bleeding during your periods or severe cramping, and they interfere with regular activities, make an appointment to see your doctor.

Causes:


The cause of adenomyosis isn't known. Expert theories about a possible cause include:

• Invasive tissue growth. Some experts believe that adenomyosis results from the direct invasion of endometrial cells from the surface of the uterus into the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) may promote the direct invasion of the endometrial cells into the wall of the uterus.
• Developmental origins. Other experts speculate that adenomyosis originates within the uterine muscle from endometrial tissue deposited there when the uterus first formed in the female fetus.
• Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. An inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
• Stem cell origins. A recent theory proposes that bone marrow stem cells may invade the uterine muscle, causing adenomyosis.

Regardless of how adenomyosis develops, its growth depends on the circulating estrogen in a woman's body. When estrogen production decreases at menopause, adenomyosis eventually goes away.

Complications:


Although not harmful, the pain and excessive bleeding associated with adenomyosis can have a negative effect on your lifestyle. You may find yourself avoiding activities that you previously enjoyed because you have no idea when or where you might start bleeding. Painful periods can cause you to miss work or school and can strain relationships. Recurring pain can lead to depression, irritability, anxiety, anger and feelings of helplessness. That's why it's important to seek medical evaluation if you suspect you may have adenomyosis.
If you experience prolonged, heavy bleeding, chronic anemia may result.

Treatments and drugs:


Adenomyosis usually goes away after menopause, so treatment may depend on how close you are to that stage of life.
Treatment options for adenomyosis include:

• Anti-inflammatory drugs. If you're nearing menopause, your doctor may have you try anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take it during your period, you can reduce menstrual blood flow and help relieve pain.
• Hormone medications. Controlling your menstrual cycle through combined estrogen-progestin oral contraceptives or through hormone-containing patches or vaginal rings may lessen the heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device containing progestin or a continuous-use birth control pill, often leads to amenorrhea — the absence of your menstrual periods — which may provide relief.
• Hysterectomy. If your pain is severe and menopause is years away, your doctor may suggest surgery to remove your uterus (hysterectomy). Removing your ovaries isn't necessary to control adenomyosis.