Adenomyosis is a condition of the uterus (womb) where the cells that normally form a lining on the inside of the uterus, also grow in the muscle wall of the uterus.
Causes, signs and symptoms of adenomyosis, along with how it is diagnosed and treated, are all discussed.
What is adenomyosis?
What causes adenomyosis?
What are the signs and symptoms?
Where does adenomyosis occur?
What happens when you get a period?
Diagnosis
Treatment
When to seek help
The term adenomyosis comes from the words:
Adenomyosis is a condition of the uterus (womb) where cells similar to the lining on the inside of the uterus are present in the muscle wall of the uterus.
Although women with adenomyosis often have endometriosis they are different conditions. With endometriosis, cells similar to those that line the uterus are found in other parts of the body such as the fallopian tubes, the ovaries or the tissue lining the pelvis (the peritoneum).
The cause of adenomyosis is unknown; however there are a number of theories:
Adenomyosis is only seen in women in their reproductive years because its growth requires oestrogen. After menopause, adenomyosis usually goes away because of the lack of oestrogen.
The known risks for developing adenomyosis are:
Because of the link with childbirth or uterine surgery, adenomyosis is more likely to occur in women between 30-50 years.
The most common symptoms are:
Adenomyosis is most likely to occur in the muscle layer of the back wall of the uterus but can occur anywhere in the muscle layer.
If adenomyosis is concentrated in one area, it can lead to a mass called an adenomyoma.
The lining cells in the muscle undergo the same changes as the lining cells of the uterus. This means when you have your period, these cells also bleed but because they are trapped in the muscle layer they form little pockets of blood within the muscle.
Adenomyosis may be difficult to diagnose. The main test recommended is a transvaginal ultrasound (the ultrasound probe is placed in the vagina). The test should preferably be performed by a gynaecologist who specialises in ultrasound, as general ultrasonagraphers may be inexperienced in the diagnosis of adenomyosis.
MRI (magnetic resonance imaging) can be useful in diagnosing adenomyosis because it collects pictures of soft tissue such as organs and muscles that don't show up on X-ray examinations.
Adenomyosis is often only diagnosed by pathology tests conducted after the uterus has been removed (hysterectomy).
Adenomyosis is difficult to treat and it will disappear after menopause so management will depend on your life stage. The following are some treatment options:
| Treatment | How it works |
|---|---|
| Progestogen releasing intrauterine device (IUD) such as Mirena | The insertion of an IUD can cause:
|
| GnRH agonists (an artificial hormone used to prevent natural ovulation) | GnRH agonists cause:
In the presence of infertility and endometriosis these may be used temporarily. |
| Hysterectomy | Hysterectomy is the complete removal of the uterus (and therefore the adenomyosis) |
| Laparoscopy (keyhole surgery) | An adenoyoma may be surgically removed using keyhole surgery. |
| Ultrasound | Guided by an MRI, high intensity focused ultrasound waves cause a localised increase in temperature to the adenomyoma causing the cells to die. |
Seek help when your symptoms are: