What is Adenomyosis?
Adenomyosis — also known as “uterine endometriosis” or endometriosis interna — is a common condition where the endometrium (the inner lining of the uterus) encroaches or breaks into the myometrium (the muscle wall of the uterus).
This can cause the uterine wall to grow thicker, and result in painful menstrual cramps, pain during intercourse, heavy periods and bloating prior to menstrual periods.
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Adenomyosis is most common in women further into their childbearing years, after they’ve had children. It usually disappears after menopause once estrogen production drops, however, it can cause severe discomfort for many years for some women.
Fortunately, there are certain treatments available.
Symptoms of Adenomyosis
How severe the symptoms of adenomyosis are will depend on the degree of penetration of the endometrium into the myometrium. Sometimes, encroachment can be only minor, resulting in very mild symptoms. But for more serious cases, symptoms can be quite severe.
• Heavy periods (Menorrhagia)
• Painful periods (Dysmenorrhea)
• Blood clots in menstrual bleeding
• Prolonged menstrual period and cramps
• Pain during intercourse and pelvic examinations
• Abdominal pain, tenderness and bloating
• An enlarged or hardened uterus
• Back pain
If you have any of these symptoms, especially heavy periods or severe cramping, you should book an appointment with your gynaecologist.
Causes and Risk Factors
The exact cause of adenomyosis is unknown, however, we do know its development is linked with the production of estrogen.
There are certain theories for how cells from uterus lining enter the muscle wall in the first place, resulting in adenomyosis. Some believe it can happen during surgery, such as a cesarean section. Another theory is that it originates from endometrial tissue that is deposited in the uterine muscle during foetal growth. Another links adenomyosis with childbirth, during which the uterus is weakened by inflammation.
Risk factors for its development include:
• Age — most women that suffer from adenomyosis are in their 40s or 50s, prior to menopause, although it can happen in women as young as teenagers.
• Having had children
• Having had surgery, such as a cesarean section or fibroid removal.
For most women, adenomyosis and its symptoms disappear after menopause. Sometimes symptoms can be quite mild and treatment may not be necessary. But symptoms can be quite severe for some women and greatly impact day-to-day life.
The only definitive cure for adenomyosis is removal of the uterus (hysterectomy), and this may be advisable for women with very severe symptoms. However, there are effective management options available too:
Anti-Inflammatory Medication: This can be an effective way to relieve cramps and reduce menstrual bleeding. Medications such as ibuprofen can be taken a few days before your period begins for a few days throughout to help manage symptoms
Hormone Therapy: Hormone therapy is another effective way to treat heavy bleeding and painful cramps. These include progestin releasing IUD’s such as Mirena, aromatase inhibitors and GnRH analogs. These treatments can help to control the estrogen levels that may be contributing to your symptoms.
Surgery: Such as an endometrial ablation — a minimally invasive procedure to remove the endometrium (lining of the uterine cavity) — is usually ineffective, as it does not treat the disease which extends deeply into the uterine wall.
Uterine artery embolisation — a procedure that cuts off the supply of blood to the affected area in the uterine muscle wall — has been shown in our hands to be an effective way to avoid hysterectomy. Nonetheless, hysterectomy may prove to be the only viable option for you.
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