Adenomyosis - Symptoms, Causes, Management, and Prevention

What Is Adenomyosis?

Adenomyosis occurs when the tissue that usually lines the uterus (endometrial tissue) grows into the muscular wall of the uterus. As a result, the thickened and enlarged uterus may lead to abnormal uterine bleeding and painful periods. Adenomyosis commonly occurs in adolescents or females between the ages of 35 and 50 who have at least one pregnancy, endometriosis, or uterine fibroids.

What Is the Difference Between Adenomyosis and Endometriosis?

Adenomyosis and endometriosis terms are often confused, but they are entirely different. Both the conditions involve endometrial tissue, pain, and heavy menstruation. However, the difference between these conditions is where the endometrial tissue grows -

• Adenomyosis: Endometrial tissue grows into the muscle of the uterus.

• Endometriosis: Endometrial tissue grows outside the uterus (may involve the ovaries, pelvic sidewalls, fallopian tubes, or bowel).

What Are the Symptoms of Adenomyosis?

Symptoms range from mild to severe. The most common symptoms:

• Heavy or prolonged menstrual bleeding (menorrhagia).

• Painful menstrual cramps (dysmenorrhea).

• Menstrual bleeding with blood clots.

• Painful sexual intercourse (dyspareunia).

• Infertility.

• Enlarged uterus.

• Frequent urge to urinate.

• Pelvic pain.

• In some cases, there will be a complete lack of symptoms. Hence adenomyosis remains undiagnosed.

What Causes Adenomyosis and Who Is at Risk?

The exact causes of adenomyosis are not known, but the following theories explain the probable causes:

• Invasive Tissue Growth - Endometrial cells from the uterus lining invade the muscle that forms the uterine walls. Uterine incisions during an operation such as a cesarean section (C-section) increase the risk.

• Developmental Origin - Endometrial tissue that got deposited in the uterine muscle in the fetal stage.

• Uterine Inflammation - Inflammation of the uterine lining after childbirth may cause a break in the normal boundary of cells that line the uterus.

• Stem Cell Origin - Bone marrow stem cells might invade the uterine muscles, causing adenomyosis.

Risk Factors for Adenomyosis:

• Uterine surgery like C-section, fibroid removal, or dilatation and curettage (D and C).

• Childbirth.

• Middle-aged women.

• Breast cancer treatment drug Tamoxifen.

• Other factors like ectopic pregnancy (when a fertilized egg implants and grows outside the main cavity of the uterus), smoking, depression, and the use of anti-depressants.

How Is Adenomyosis Diagnosed?

Based on the severity of symptoms, the following tests can be performed:

• Pelvic Examination - To check for swollen, enlarged, or painful uterus.

• Ultrasound - Transvaginal ultrasound to check the thickness of the uterine wall.

• Imaging Scans - Magnetic resonance imaging (MRI) scans.

• Biopsy - Biopsy can only be performed after hysterectomy (complete surgical removal of the uterus).

What Is the Treatment of Adenomyosis?

Medical treatment is usually not required for mild to moderate cases. Following treatment can be done to relieve the symptoms.

1. Anti-Inflammatory Medications - Anti-inflammatory medications like Ibuprofen help reduce blood flow during periods and relieve cramps. Pregnant women should consult a doctor before taking this medication. A warm bath or heating pad on the abdomen also helps ease pelvic pain and cramps related to adenomyosis.

2. Hormonal Treatments - Hormonal treatment helps control the estrogen level, which is the main reason for the symptoms.

Treatment includes:

• Gonadotropin-releasing hormone (GnRH) analogs.

• Oral contraceptives (birth control pills).

• Progestin-only contraceptives (pill, intrauterine device [IUD], or injection).

3. Endometrial Ablation - Endometrial ablation is the technique to remove or destroy the endometrium. The success rate of this treatment is not very high in cases of deeper invasion of muscles by the endometrium. It is recommended for people who have already had children and do not plan any future pregnancies. It is a short procedure with rapid recovery.

4. Uterine Artery Embolization - Uterine artery embolization stops the blood supply to the affected area. It is a minimally invasive procedure in which an embolic agent is injected into uterine arteries to induce ischemic infarction of adenomyotic foci. It does not cause any scar formation on the uterus.

5. Ultrasound-Guided Focused Ultrasound Surgery - Ultrasound-guided focused ultrasound surgery uses high-intensity waves to generate heat and destroy the targeted tissue. The process is monitored using ultrasound images in real-time.

6. Hysterectomy - Hysterectomy is considered the only way to cure adenomyosis completely. It is a significant surgical intervention that involves complete surgical removal of the uterus. Only used in severe cases and people who do not wish to pursue pregnancy in the future. The disease usually resolves after menopause.

What Are the Complications of Adenomyosis?

• Increased risk of anemia (iron deficiency, fatigue, dizziness, and moodiness).

• Negative effect on lifestyle.

• Anxiety, depression, and irritability.

• Women with adenomyosis are likely to have other uterine conditions such as uterine fibroids, endometriosis, or endometrial polyp.

What Is Adenomyosis Belly?

The endometrial tissue causes the uterine walls to grow thicker over time and put pressure on surrounding organs like the bladder or the intestines, leading to protrusion of the abdomen- nicknamed as "adenomyosis belly."

How Does Adenomyosis Affect Pregnancy?

Adenomyosis primarily affects women who have had at least one child. It is not very easy to conceive a baby with this condition. A pregnant woman with adenomyosis has an increased risk of:

• Miscarriage (loss of pregnancy).

• Premature labor (childbirth before the 37th week of pregnancy).

How to Prevent Adenomyosis?

Since the exact causes of adenomyosis are not known, the measures to prevent adenomyosis are also not known to the healthcare providers. Only symptomatic relief can be obtained. Patients must follow a special diet for adenomyosis for a better prognosis.

What Is the Prognosis for People With Adenomyosis?

• The disease tends to get worse with time.

• Symptomatic relief through hormonal treatment and painkillers.

• Hysterectomy is a permanent solution that provides long-term relief.

• Adenomyosis goes away on its own after menopause.

• No risk of adenomyosis developing into cancer.

Conclusion

Adenomyosis symptoms can range from mild to moderate to severe. The presence of painful cramps and prolonged heavy bleeding cause severe discomfort and disrupts the everyday lifestyle, and negatively impact a woman's quality of life.

The prognosis for a woman with adenomyosis is good; it is benign (not a life-threatening condition), so measures are taken to ease the symptoms along with medical or surgical interventions according to the need. Adenomyosis will go away once a woman reaches menopause.