Adenomyosis Symptoms and Treatments

If you have very painful periods with or without heavy menstrual bleeding it is possible that you have a benign gynecologic condition called adenomyosis.

What Is Adenomyosis?

Adenomyosis occurs in the uterus and is a common cause of painful periods and heavy menstrual bleeding.

Your uterus is made of smooth muscle that is lined with a special layer called the endometrium. The endometrium is what builds up and sheds in response to changes in your hormone levels during your menstrual cycle every month. Normally the endometrium is separated from the muscle layer of the uterus or the myometrium. In women who have adenomyosis, the endometrial lining has spread into the muscular wall of the uterus.

These areas of endometrium embedded in the wall of the uterus undergo the same hormonal changes as the normal endometrium. These changes result in irritation and inflammation in the muscle of the uterus resulting in pain and altered blood flow that causes heavier menstrual bleeding.

Causes

The cause of adenomyosis is still up for debate in the medical community.

 It appears, however, that injury or disruption of the lining of the uterus is a significant risk factor for adenomyosis. If you have had a least one pregnancy or miscarriage you are more likely to develop adenomyosis than a woman who has had never been pregnant. You are at even greater risk if you have had a surgical evacuation of pregnancy or have delivered a child by a cesarean section.

Typically adenomyosis occurs after the age of 30 with the peak age of diagnosis between the ages of 40-50 years old.Adenomyosis can occur in teenage girls however it is much less common. But the diagnosis should certainly be considered in a teenage girl having extremely painful periods that do not respond to usual treatments.

Because the lining of the uterus has spread into the muscular layer, a uterus affected by adenomyosis will increase in size. This size increase is diffuse meaning that the entire uterus increases in size, similar to how the uterus increases in the early part of pregnancy. On a pelvic exam, your healthcare provider may be able to detect that the size of your uterus has increased. The term used to describe this change is globular.The deeper into the muscle wall the adenomyosis goes the more severe the symptoms.

Symptoms

While many women who have adenomyosis are asymptomatic, women who do experience symptoms may have severe dysmenorrhea and heavy menstrual bleeding. It is not uncommon that if you are diagnosed with adenomyosis you may also be diagnosed with uterine fibroids or endometriosis.The combination of these benign gynecologic conditions can result in increased severity of the symptoms of painful periods and heavy menstrual bleeding.

Diagnosis

If your healthcare providers suspect that you have adenomyosis she will likely order a transvaginal ultrasound or an MRI of your pelvis. These imaging studies do a fairly good job of confirming the diagnosis. In some situations, your healthcare provider may suggest a biopsy of the wall of your uterus to confirm the diagnosis of adenomyosis although this is not typically indicated.

Treatment

Once you are diagnosed with adenomyosis your healthcare provider will likely suggest different treatment options. The option that is right for you will depend on your age, the severity of your symptoms, your plans for future pregnancies, and whether or not you also have uterine fibroids or endometriosis. Your healthcare provider may suggest that you try medical management before considering a surgical option. The goal of medical treatment is to control the symptoms of painful periods and heavy menstrual bleeding.

Medications that your healthcare provider may suggest include:

• NSAIDs
• Oral contraceptive pills
• GnRH agonists

Mirena (progestin-containing intrauterine device) may also used to manage adenomyosis.

These medical options may or may not help your symptoms. Of these medical options, the evidence suggests that the Mirena IUD may be the most effective in controlling the symptoms of adenomyosis.

If medical management fails to control your symptoms and you are done having children, your healthcare provider may suggest a surgical option. The most definitive surgical treatment is removing your uterus a surgery known as a hysterectomy. Depending on the extent of the adenomyosis your healthcare provider may discuss other options that would allow you to keep your uterus. These options include:

• Endometrial ablation
• Uterine artery embolization
• Myometrial resection

Updated by Andrea Chisholm, MD