Adenomyosis

Adenomyosis is when endometrial glands and stroma are found in the myometrium (the uterus muscles). Normally, these glands and stroma should only be found in the lining of the uterus. 

As the myometrium gets more extensive, so does the uterus.

Last Updated: February 21, 2024

Most experts agree that between 20 and 35 percent of women have adenomyosis.

Adenomyosis seems to affect more women who have had children than women who have never had children. But having more pregnancies does not put a woman at a higher risk of getting the disease.

Adenomyosis also often happens along with other uterine diseases, especially uterine leiomyomas and endometriosis. Because of this, it is hard to identify the risk factors and the progression of this disease 

 

The exact cause of adenomyosis remains unknown. But experts have found that the hormones and the area of the uterus between the endometrium and myometrium, called the endomyometrium, play a role.

Women with adenomyosis often don't have any signs or symptoms. However, some women experience the following:

  • Painful menstrual cramps (dysmenorrhea);
  • Heavy bleeding during periods (menorrhagia);
  • Abnormal menstruation;
  • Pelvic pain;
  • Dyspareunia (pain during sexual intercourse)
  • Infertility;
  • Enlarged uterus.

Doctors perform a pelvic examination to inspect the uterus and check for the presence of adenomyosis. Patients with adenomyosis often have a uterus that is movable, diffusely enlarged (commonly called "globular" enlargement), and soft on a bimanual pelvic examination (often referred to as "boggy").

A transvaginal ultrasound (TVUS) is the imaging modality for assessing uterine enlargement, pelvic discomfort, or irregular bleeding. When an accurate diagnosis is crucial to determine care, such as when differentiating between diffuse and focal adenomyosis and leiomyomas, magnetic resonance imaging (MRI) is reserved for such patients.

A biopsy is often necessary to rule out endometrial hyperplasia or malignancy when evaluating for adenomyosis because a patient may frequently present with abnormal uterine bleeding.

 

Treatment

The primary factor in determining the best course of treatment is the patient's desire to conceive. Currently, the only effective treatment is a hysterectomy. The remaining choices aim to alleviate the primary symptoms of monthly cramping and bleeding while leaving the uterus intact.

Drugs

  • Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) for the cramping pains of menstruation.
  • Several hormonal medications, such as oral contraceptive pills (OCPs), a levonorgestrel intrauterine device (IUD), danazol, and aromatase inhibitors, can reduce the effects of estrogen that cause endometrial growth.

Minimally Invasive Treatment or Surgery

  • Focal disease can be targeted with MRI- or ultrasound-guided high-intensity ultrasound thermal ablation.
  • Uterine artery embolization cuts off blood flow to the whole uterus. This causes necrosis, which causes the uterus to shrink.
  • Myomectomy and partial hysterectomy are more invasive options that try to preserve fertility. These choices make it possible to focus on a deeper issue.

Experts agree that, presently, there is no way to prevent adenomyosis. However, there are ways to control the symptoms. These methods may help alleviate adenomyosis-related pelvic pain and cramping:

  • Get a warm bath;
  • Apply heat to your abdomen;
  • Use an over-the-counter NSAID like ibuprofen to reduce swelling and pain.

 

References

Gunther R, Walker C. Adenomyosis. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539868/

 

Cleveland Clinic (2022). Adenomyosis. Retrieved November 9, 2022, https://my.clevelandclinic.org/health/diseases/14167-adenomyosis

 

Stewart, EA. Adenomyosis. [Updated 2022 Oct]. UptoDate [Internet]. Wolters Klower; 2022 Mar-. Available from: https://www.uptodate.com/contents/uterine-adenomyosis#H1628887227

Last Updated: February 21, 2024