Adenomyosis is a condition in which the inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (myometrium). This can cause symptoms like heavy menstrual bleeding, severe menstrual
cramps, chronic pelvic pain, and an enlarged uterus. The treatment of adenomyosis depends on the severity of the symptoms, the patient's age, and whether they wish to preserve fertility.
Adenomyosis is a condition where the inner lining of the uterus
(endometrium) breaks through the muscle wall of the uterus (myometrium). This can cause a variety of symptoms, ranging from mild to severe.
The most common symptoms include :
- Heavy or prolonged menstrual bleeding (menorrhagia) : Excessive bleeding during menstruation.Menstrual cycles that last longer than normal.
- Severe menstrual cramps (dysmenorrhea) : Painful periods that can worsen over time. Cramping may start earlier and last longer than usual.
- Pelvic pain or discomfort / Chronic pelvic pain : Persistent pain in the pelvic area that can occur outside of menstruation. Tenderness or discomfort in the lower abdomen.
- Enlarged or tender uterus : The uterus may feel bulky or enlarged, and it may be tender to the touch.Some women may notice bloating or a feeling of pressure in the lower abdomen.
- Pain during intercourse (dyspareunia):
When to See a Doctor :
If you experience heavy, prolonged periods, severe cramping, or persistent pelvic pain, it's important to consult a healthcare professional. Adenomyosis can mimic symptoms of other conditions like endometriosis or uterine fibroids, so a thorough evaluation is necessary for accurate diagnosis.
Adenomyosis is a gynecological condition characterized by the presence of endometrial tissue (glands and stroma) within the muscle layer (myometrium) of the uterus. This causes the uterine wall to thicken and can result in various symptoms, such as heavy menstrual bleeding and pelvic pain.
Here’s how adenomyosis is diagnosed:
Clinical Evaluation :The initial diagnosis often starts with a thorough medical history and physical examination, including symptoms like Heavy and prolonged menstrual bleeding (menorrhagia), Severe menstrual cramps (dysmenorrhea), Chronic pelvic pain, Pain during intercourse (dyspareunia), Enlarged, tender uterus on pelvic examination.
Imaging Studies :In clinical practice, the diagnosis of adenomyosis is typically made based on a combination of symptoms,
physical exam, and imaging findings. Non-invasive imaging is key for diagnosis. The two most commonly used imaging modalities are Ultrasound (Transvaginal Ultrasound) andMagnetic Resonance Imaging (MRI)
Ultrasound (Transvaginal Ultrasound) helps to find Diffusely enlarged uterus, Asymmetrical thickening of the myometrium, Heterogeneous appearance of the myometrium, Myometrial cysts (small cystic spaces within the myometrium), Poorly defined endometrial-myometrial junction.
Magnetic Resonance Imaging (MRI) helps in finding Thickening of the junctional zone (≥12 mm is suggestive of adenomyosis), High-intensity areas on T2-weighted images (representing myometrial cysts or hemorrhagic areas), Diffuse or focal areas of low-signal intensity on T2-weighted images (indicative of hypertrophic myometrium). Provides detailed images and is more specific than ultrasound, especially useful in differentiating adenomyosis from fibroids.
Histopathological Diagnosis: Histological confirmation is often made after hysterectomy when the uterus can be examined in its entirety. In the Microscopic Findings, Endometrial glands and stroma are
found within the myometrium, at least 2-3 mm below the endometrial-myometrial junction.
Differential Diagnosis : It’s important to differentiate adenomyosis from:
- Uterine Fibroids (Leiomyomas) : Benign tumors that can cause similar symptoms. Fibroids are usually well-circumscribed, whereas adenomyosis is diffuse.
- Endometriosis : Often co-exists with adenomyosis but involves endometrial tissue outside the uterus.
- Endometrial Hyperplasia / Carcinoma :May present with abnormal bleeding.
The treatment of adenomyosis depends on the severity of the symptoms, the patient's age, and whether they wish to preserve fertility. Here’s a comprehensive overview of treatment options:
Conservative (Non-surgical) Management : This approach is often recommended for women with mild symptoms or those wishing to preserve fertility.
a. Medications :
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): E.g., ibuprofen, naproxen. Help reduce pain and menstrual cramps.
- Hormonal Therapy:
- Oral Contraceptives (Pills): Regulate the menstrual cycle and reduce bleeding.
- Progestin-only Therapy: Includes pills, injections (e.g., medroxyprogesterone), or an intrauterine device (IUD) like the levonorgestrel IUD (Mirena), which can reduce heavy bleeding and pain.
- Gonadotropin-Releasing Hormone (GnRH) Agonists: Medications like leuprolide (Lupron) induce a temporary menopausal state, reducing symptoms by lowering estrogen levels.
- Aromatase Inhibitors: Reduce estrogen production and can help relieve symptoms.
- Tranexamic Acid:
- An antifibrinolytic medication used during menstruation to reduce heavy bleeding.
Surgical Management :Recommended for severe cases or when conservative treatments fail.
a. Hysterectomy
- The definitive treatment for adenomyosis involves the removal of the uterus. It is usually considered for women with severe symptoms who do not wish to preserve fertility. Can be performed via abdominal, vaginal, or laparoscopic approaches.
b. Adenomyomectomy
- A fertility-preserving surgery where only the affected tissue is removed. It is technically challenging and carries a higher risk of complications but may be an option for women seeking to maintain
reproductive potential.
Key Considerations
- Fertility: Treatment options may be limited for women who wish to conceive, and careful consideration is needed.
- Menopause: Symptoms of adenomyosis often improve after menopause due to the natural decline in estrogen levels.
