Adenomyosis

Adenomyosis is a benign (non-cancerous) condition where the tissue that normally lines the inside of the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium). Each month, this trapped tissue responds to hormonal cycles, causing the muscle wall to swell and bleed internally.

This leads to an enlarged, tender, and boggy uterus. While it can cause significant symptoms, it is not dangerous or life-threatening. It is distinct from endometriosis, though the two conditions can co-exist.

It most commonly affects women in their 30s, 40s, and those who have had children. The symptoms often improve after menopause when hormone levels fall, and it does not increase your risk of uterine cancer.

Common Symptoms

About one-third of women with adenomyosis have no symptoms. For others, symptoms can be severe and include:

• Heavy Menstrual Bleeding (Menorrhagia): Extremely heavy, prolonged periods, often with blood clots.
• Severe Painful periods (Dysmenorrhea): Intense, debilitating pelvic pain or pressure during periods, which may begin before bleeding starts and last throughout.
• Chronic Pelvic Pain: Aching or pressure in the pelvis, lower back, and thighs, not just during periods.
• Pain During Intercourse (Dyspareunia).
• Bloating & Enlarged Abdomen: The uterus can become significantly enlarged, feeling tender to pressure.
• Irregular Bleeding: Spotting between periods.

Causes & Risk Factors

The exact cause is unknown. Leading theories suggest it may be due to:

• Invasion of Endometrial Tissue: Direct invasion of endometrial cells into the uterine muscle wall.
• Developmental Origins: Tissue deposited in the muscle during fetal development.
• Uterine Inflammation: Related to childbirth or surgery.

Risk factors may include

• Childbirth (particularly multiple births).
• Prior Uterine Surgery (e.g., C-section, fibroid removal).
• Middle Reproductive Age (30s-40s).
• Early Menarche (starting periods at a young age).

Diagnosis

Adenomyosis can be challenging to diagnose as its symptoms overlap with other conditions like fibroids or endometriosis. A definitive diagnosis is only confirmed after hysterectomy and pathology examination. However, a strong clinical suspicion can be made using:

• Pelvic Ultrasound: The first-line imaging tool. A skilled gynaecologist or sonographer may see an enlarged uterus with a characteristic “swiss cheese” or “starry sky” appearance or venetian blind pattern in the muscle wall.
• Magnetic Resonance Imaging (MRI): The gold standard for non-surgical diagnosis. It provides detailed images to confirm adenomyosis and rule out other conditions.
• Pelvic Examination: Your gynaecologist may feel a soft, diffusely enlarged, and tender uterus.

Management & Treatment Options

Treatment is tailored to your symptoms, age, and desire for future pregnancy.

Medical Management (To Control Symptoms)

• Pain Relief: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce pain and bleeding.
• Hormonal Therapies:
  • Progestin-Only Options: The hormonal IUS (Mirena), contraceptive or progestin pills (Desogestrel/Dienogest) are often first-line to lighten bleeding and reduce pain.
  • Combined Hormonal Contraceptives: The pill, patch, or ring to regulate or stop periods.
  • GnRH Agonists: Induce a temporary, reversible menopause to shrink the uterus and relieve symptoms. Used short-term due to side effects (bone loss, hot flushes).
  • Newer Oral Treatments: Relugolix combination therapy can also be effective for heavy bleeding from adenomyosis.

• Uterine Artery Embolization (UAE): Minimally invasive procedure that blocks blood supply to the affected area, shrinking it and relieving symptoms.
• Endometrial Ablation: Destroys the uterine lining. Best for mild, superficial adenomyosis. Not suitable if future pregnancy is desired.
• MRI-Guided Focused Ultrasound (MRgFUS): A non-invasive treatment using ultrasound energy to target and destroy adenomyosis tissue.
• Hysterectomy: The only definitive cure. This involves surgically removing the uterus. It is considered when symptoms are severe and childbearing is complete.

Possible Complications & Long-Term Outlook

• Anaemia: Chronic heavy bleeding can lead to iron-deficiency anaemia, causing fatigue and shortness of breath.
• Reduced Quality of Life: Chronic pain and heavy bleeding can significantly impact daily activities, work, and mental health.
• Infertility & Pregnancy: Adenomyosis may be associated with a slightly higher risk of infertility, miscarriage, and preterm birth. However, many women with adenomyosis conceive and have healthy pregnancies.
• Post-Menopause: Symptoms typically resolve after menopause.

Frequently Asked Questions (FAQs)

Q: Is adenomyosis the same as endometriosis?
A: No. Endometriosis is when endometrial-like tissue grows outside the uterus (e.g., on ovaries, bowel). Adenomyosis is when it grows into the uterine muscle wall. They can occur together and share similar symptoms.

Q: Does adenomyosis mean I have cancer or will get cancer?
A: No. Adenomyosis is a benign condition. It does not increase your risk of developing uterine (endometrial) cancer.

Q: Can I still get pregnant if I have adenomyosis?
A: Yes, many women do. It may be more challenging for some, and pregnancy may require closer monitoring. Discuss your fertility goals with a gynaecologist or fertility specialist.

Q: Will a hysterectomy cure my adenomyosis?
A: Yes. Since adenomyosis is confined to the uterus, removing the uterus (hysterectomy) is a definitive cure. This is a major decision and only an option if you do not wish to have (more) children.

Q: Is there a special diet for adenomyosis?
A: While no diet cures it, an anti-inflammatory diet (rich in fruits, vegetables, omega-3s) may help manage systemic inflammation and pain. Ensuring adequate iron intake is important to combat anaemia from heavy bleeding.

eGynaecologist Advice

• You should seek gynaecological consultation if you experience progressively worsening heavy menstrual bleeding and severe period pain that disrupts your life. Early diagnosis can prevent anaemia and improve your quality of life.
• You should have your blood counts and iron levels checked regularly if you have heavy periods, to diagnose and treat anaemia promptly.
• You must explore alternative treatment options before considering major surgery like a hysterectomy, especially if you wish to preserve your fertility or uterus.