Adenomyosis is functioning endometrial tissue within the uterine myometrium. This benign invasion of the uterine wall's middle layer has been described as a variation of endometriosis and while the illnesses can coexist, they are different diagnoses.
Menorrhagia and dysmenorrhoea are the most common symptoms of adenomyosis, which is commonly associated with fibroids.
Adenomyosis is identified in up to 40% of hysterectomy specimens, regardless of previous history of pelvic pain, and is most common in multiparous women at the end of their reproductive lives (70% to 80% of cases are reported in women in their forties and fifties). Because ectopic endometrial tissue is hormone-responsive, symptoms subside after menopause.
The amount of adenomyosis and the severity of the symptoms vary greatly between individuals. Approximately 1/3rd of women have no symptoms at all, while for others, symptoms can interfere with everyday life.
Adenomyosis symptoms may include:
- Heavy menstrual bleeding
- Very painful periods
- Pain during sex
- Bleeding between periods
- Worsening uterine cramps
- An enlarged and tender uterus
- General pain in the pelvic area
- A feeling that there is pressure on the bladder and rectum
- Pain while having a bowel movement
The invasion of the endometrial basal layer into the myometrium causes adenomyosis. Endometrial tissue has two layers: the basal layer and the functional layer. After menstruation, the basal layer, or the deepest section of tissue that connects to the myometrium, is in charge of regeneration. During menstruation, this layer does not shed. The functional layer is the layer of tissue that lines the uterus. If the egg is not fertilized, the functional layer proliferates throughout the menstrual cycle and subsequently sheds during menstruation.
Several factors have been investigated that may enhance the risk of getting adenomyosis. Although the mechanism is uncertain, estrogen, progesterone, and past uterine surgery are thought to contribute to the development of adenomyosis. It has also been related to increased aromatase levels, an enzyme responsible for estrogen synthesis. According to research, age and parity may play an effect. The risk of adenomyosis appears to diminish after menopause, most likely due to changes in hormone levels such as progesterone, estrogen, prolactin, and follicle-stimulating hormone (FSH).
Adenomyosis is diagnosed histologically, which involves a microscopic examination of the uterus and, as a result, a hysterectomy, which is not an option for young women who want to become pregnant.
However, imaging procedures such as pelvic ultrasound and pelvic MRI can now be used to accurately diagnose adenomyosis.
There are several types of adenomyosis, including diffuse forms (in which microcysts are dispersed somewhat equally throughout the uterine cavity) and localized ones (foci of adenomyosis with or without a connection to the uterine cavity).
Adenomyosis is usually encountered in cases of rectum or bladder endometriosis, where uterine lesions occur in continuity with rectum or bladder ectopic lesions.
Treatment for adenomyosis is determined in part by your symptoms, the severity of your symptoms, and whether you have finished childbearing. Mild symptoms can be managed with over-the-counter pain relievers and a heating pad to help with cramping.
Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to treat minor pain associated with adenomyosis. NSAIDs are usually taken one to two days before the start of your menstruation and continued for the first several days.
Hormonal therapies such as a levonorgestrel-releasing IUD (inserted into the uterus), aromatase inhibitors, and GnRH analogues can control symptoms such as heavy or painful periods.
Uterine artery Embolization
In this minimally invasive surgery, small particles are utilized to block the blood vessels that supply blood to the adenomyosis. The particles are directed via a small tube placed into the patient's femoral artery by the radiologist. Adenomyosis diminishes when the blood supply is cut off.
This procedure destroys the uterine lining in a minimally invasive manner. When adenomyosis has not progressed deeply into the muscle wall of the uterus, endometrial ablation can be useful in reducing symptoms in some patients.
Adenomyosis When To Visit a Doctor?
You should visit your doctor if you experience:
- Extremely heavy periods
- Severely painful cramps
- Painful intercourse