Adenomyosis 101

Adenomyosis 101

What Is It

Adenomyosis is a condition in which tissue similar to the lining of the uterus (endometrium) starts to grow into the muscular wall of the uterus (myometrium). This can cause the uterus to thicken or enlarge. This abnormal tissue reacts to hormonal changes throughout the cycle (much like endometriosis), which can cause pain and heavy bleeding with periods. Adenomyosis can cause painful periods, heavy or prolonged menstrual bleeding with clotting, and abdominal/pelvic pain. 

Difference Between Endometriosis and Adenomyosis

Endometriosis and adenomyosis are both painful and progressive disorders that involve abnormal growth of endometrial-like tissue. The main difference between the two diseases is where that tissue grows; in endometriosis, it grows outside of the uterus, while in adenomyosis, it grows deep into the muscular wall of the uterus itself, causing it to thicken. Endometriosis and adenomyosis are two distinct conditions, but many women suffer from both at once. 

Symptoms

Symptoms of adenomyosis include: 

• Painful periods

• Heavy menstrual bleeding that includes clots

• Abnormal bleeding (bleeding between periods)

• Leg pain during period

• Painful sex

• Chronic pelvic pain

• Bloating or fullness in your belly 

• Infertility

• Enlarged uterus 

Like endometriosis, some women with adenomyosis may not experience any symptoms. Others may experience debilitating symptoms, such as pain and heavy bleeding. 

What causes it 

The exact cause (or causes) is still unknown due to lack of research, but doctors and researchers believe there are certain factors linked to the development of the disease:

• Injury to or inflammation of the uterus

• Prolonged exposure to estrogen

• Exposure to progesterone or prolactin

• Previous uterine surgery or childbirth 

Although anyone with a uterus can develop adenomyosis, there are certain factors that can increase someone’s risk:

•  Between 35-50 years of age

• Multiple childbirths  

• Cesarean section birth 

• Having endometriosis  

• Shorter menstrual periods (24 or fewer days between cycles)

• Have taken birth control pills 

How Is It Diagnosed

If your doctor or healthcare provider suspects adenomyosis based on your symptoms, they may order one or more of the following tests:

• Pelvic exam

• Transvaginal ultrasound

• MRI

However, the gold standard for formally diagnosing adenomyosis is pathology. The uterine tissue is removed and examined under a microscope by a pathologist, typically after a hysterectomy (removal of the uterus).

How Is It Treated

Although adenomyosis symptoms will typically resolve after menopause, there are many treatment options that can be used in the meantime:

• Medications 

• Nonsteroidal anti-inflammatory drugs (NSAIDs): can help ease pain and cramping

• Hormone medications: estrogen causes the uterine wall to thicken which can increase pain and bleeding; symptoms and menstruation can be stopped with certain hormonal contraceptives

• Surgery

• Laparoscopic deep excisional adenomyosis surgery (LEAS): adenomyotic lesions are carefully removed from the uterine wall and the uterine muscle is meticulously reconstructed layer by layer. The aim of this procedure is to prevent a hysterectomy and to allow for a future pregnancy, if desired 

• Hysterectomy or partial hysterectomy: all or part of the uterus is removed. This is the only “cure” for adenomyosis.

Treatment depends on the severity of symptoms and your personal health goals. Anti-inflammatory medications or hormonal therapies are often used first to manage pain and heavy bleeding. If symptoms are severe and medication is not effective, surgical options can be considered. 

Final Thoughts

Being diagnosed with adenomyosis can feel overwhelming and the treatment options can be scary, but certain lifestyle habits and modifications can help you manage symptoms.  If you have been diagnosed with adenomyosis (or suspect you may have it), pelvic floor physical therapy is a great place to begin your healing journey.