Adenomyosis
Adenomyoma: Growths Inside The Wall Of The Womb

to Endometrial Benign Growths


Adenomyoma picture
Adenomyoma growths in the wall of the uterus.

Adenomyosis

Contents

What Is Adenomyosis?
What Are The Symptoms?
What Causes It?
How Is It Diagnosed?
How Is It Treated?
Does Adenomyosis Cause Infertility?
Can It Cause Pregnancy Complications?


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What Is Adenomyosis?

Adenomyosis is where endometrial tissue - the tissue that normally lines the womb - grows inside the wall of the womb (uterus). It most often occurs later in a woman's childbearing years after having children. It is not the same as endometriosis - a condition where parts of endometrial tissue escape the womb and implant on organs outside it (like the fallopian tubes or ovaries). However, many women with endometriosis also have adenomyosis. While the cause of adenomyosis is unknown, it typically disappears after menopause. For women who experience severe symptoms, certain treatments can help but ultimately the only cure (if it does not resolve itself) is hysterectomy (removal of the womb).

What Are The Symptoms?

In many (probably undiagnosed) cases, it produces no symptoms, or only mild discomfort. In others, it can result in:

• Heavy menstrual bleeding (menorrhagia).
Painful periods (dysmenorrhea) which become worse over time.
• Pelvic pain during intercourse (see also, painful intercourse).
• Spotting between periods. (see also, what causes brown spotting?).
• Abdominal tenderness - adenomyosis can cause the uterus to double or triple in size. It may even cause a growth (benign tumor) in one area, which is called an adenomyoma.

What Causes It?

Scientists have still to identify the cause of adenomyosis. It is more likely to occur in women over 30 who have had children, and in those with previous uterine surgery, including cesarean section. Possible theories include:
Surgical Incision: During a surgical incision of the uterus (such as a cesarean section), endometrial cells may be moved from the surface of the uterus into the wall of the uterus, and from there continue to grow and invade surrounding tissue.
Postpartum Inflammation: It may be that the uterus lining becomes inflamed in the postpartum period after childbirth, causing a tear which allows endometrial cells to invade the tissue below.
Stem cell: Yet another theory is that bone marrow stem cells might invade the wall of the uterus causing adenomyosis.
Hormones: It may be triggered by increased hormone levels. Women with gynecological disorders triggered by high levels of hormones (estrogen, progesterone, prolactin and follicle-stimulating hormone) appear to be more prone to the condition. This could explain why symptoms improve after menopause when hormone levels decline (read about the effects of estrogen on the body).

How Is It Diagnosed?

Your doctor may notice that your uterus is enlarged during a routine pelvic examination. An ultrasound of the womb will help to differentiate between adenomyoma and other uterine tumors such as uterine fibroids, uterine polyps and endometriosis. An MRI scan will be ordered if the ultrasound does not give clear results. An endometrial biopsy can help rule out other conditions, but it cannot diagnose adenomyosis. The only way to be 100 percent certain of adenomyosis is to examine a sample of uterine tissue under a microscope after hysterectomy.

How Is It Treated?

As adenomyosis usually disappears after menopause, treatment may depend on how close the woman is to that stage in her life. Treatment options include:

Anti-inflammatory medications: Taking anti-inflammatory medications like Ibuprofen (Motrin IB or Advil for example) can help relieve pain. By starting your meds 2 or 3 days before your period, and continuing to take it during your period you can lighten blood flow and reduce pain.
Hormones: Taking the continuous birth control pill, or progestin only IUD device can lead to an absence of periods (amenorrhea) which provides some relief. Vaginal rings, another method of birth control, can also help reduce pain and blood flow.
Hysterectomy: Ultimately the removal of the womb may be recommended if pain is severe and menopause is still far away. The ovaries can still be left in place.
Ablation: Endometrial ablation, an alternative to hysterectomy, is not generally suitable for treating adenomyosis because it only destroys the endometrial lining, and not endometrial cells buried deep within the wall of the uterus.
UAE: (uterine artery embolization). Traditionally used in the treatment of fibroids, it may help to cut off blood supply to the affected area of tissue, reducing symptoms.
MRgFUS: A new non-invasive procedure, magnetic resonance-guided focused ultrasound uses high bursts of ultrasound energy to kill damaged cells and leave surrounding healthy cells unharmed. This technique shows promise in restoring fertility to women who wish to fall pregnant.

Does Adenomyosis Cause Infertility?

Increasingly more women suffering from infertility are being diagnosed with adenomyosis in fertility clinics across the United States. This does not necessarily mean that adenomyosis causes infertility - it may just that the detection rate is increasing as women delay having children until their 30s and 40s when the incidence rate of adenomyosis is naturally higher. In theory, because an adenomyoma is a structural gynecological disorder, it would be fair to assume it could have some impact on fertility. The evidence is not yet available to make this judgment call.

Can It Cause Pregnancy Complications?

In theory, adenomyosis may increase the risk of pregnancy complications by compromising the function of the uterus. Possible complications include premature labor, placenta abruption, miscarriage and need for cesarean section. However, because the condition is not often diagnosed prenatally, there is not enough evidence to draw definite conclusions.

  Related Articles on Endometrial Problems

For more endometrial issues, see the following:

Endometriosis symptoms: Endometrial implants.
Symptoms of endometrial cancer: Cancerous growths of the womb.

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