Adenomyosis: Symptoms, Causes and Diagnostic Tests

Adenomyosis is a chronic gynaecological condition that often remains undiagnosed for years due to its overlap with other menstrual disorders. According to the Indian Journal of Obstetrics and Gynaecology Research, approximately 24% of women in India who experience chronic pelvic pain are found to have adenomyosis.

When adenomyosis is left untreated, it can lead to persistent pain, severe anaemia due to excessive blood loss, reduced quality of life, and, in some cases, fertility concerns. This article covers what adenomyosis meaning is, what causes adenomyosis in the uterus and how it is diagnosed.

What is Adenomyosis?

Adenomyosis is a disorder of the uterus in which endometrial glands and stroma (additional tissue) are found within the myometrium, the thick muscular wall of the uterus. Each month, this misplaced tissue responds to hormone level changes in the same way as the normal uterine lining. However, because it is trapped within the muscle, it causes inflammation, swelling, and uterine enlargement.

The adenomyosis uterus may become two to three times its normal size. This enlargement contributes to pain, pressure, and abnormal menstrual bleeding. Although adenomyosis is not a cancerous condition, it can significantly disrupt physical and emotional well-being.

What are the Symptoms of Adenomyosis?

The severity of symptoms varies. Some women may remain asymptomatic, while others experience debilitating pain. Common adenomyosis symptoms include:

1. Heavy or prolonged menstrual bleeding
2. Severe menstrual cramps that worsen over time
3. Chronic pelvic pain
4. Pain during sexual intercourse (dyspareunia)
5. Bloating or a feeling of pelvic fullness
6. Fatigue related to blood loss and anaemia
7. Irregular menstrual cycles

What Causes Adenomyosis?

The exact causes are not fully understood. However, several theories explain how endometrial tissue becomes embedded within the uterine muscle.

1. Invasive tissue growth: Endometrial cells may invade the myometrium following childbirth or uterine surgery.
2. Developmental origin: Some evidence suggests adenomyosis may originate from misplaced tissue during fetal development.
3. Uterine inflammation: Chronic inflammation after pregnancy or gynaecological procedures may weaken the uterine boundary.
4. Hormonal influence: Oestrogen plays a significant role in stimulating tissue growth, which explains why symptoms often reduce after menopause.

What are the Risk Factors for Adenomyosis?

The risk factors for adenomyosis include:

1. Age between 40 and 50 years
2. Previous childbirth
3. Prior surgeries, like caesarean section or curettage
4. Long-term exposure to oestrogen

How is Adenomyosis Diagnosed?

As adenomyosis shares symptoms with conditions such as fibroids and endometriosis, it is important to get diagnosed. Diagnosis usually involves clinical evaluation and imaging tests.

1. Pelvic examination: During a pelvic test, the uterus may feel enlarged, tender, or soft.
2. Adenomyosis ultrasound: Transvaginal ultrasound is often the first imaging test. It can identify thickened uterine walls, cystic spaces within the muscle, and an enlarged uterus.
3. Pelvic Doppler: Pelvic Doppler ultrasound assesses blood flow patterns and helps differentiate adenomyosis from fibroids and other uterine abnormalities.
4. Magnetic Resonance Imaging (MRI): MRI provides detailed adenomyosis uterus images and is considered the most accurate non-invasive test for adenomyosis, especially when ultrasound results are inconclusive.

How to Manage Adenomyosis?

Management of adenomyosis focuses on relieving pain, reducing heavy menstrual bleeding, and improving daily functioning. The management approach is selected based on symptom severity, age, and overall health. Some non-surgical and minimally invasive options include:

1. Hormone therapy to regulate menstrual cycles and reduce uterine bleeding and pain.
2. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to control menstrual cramps and pelvic pain.
3. Iron supplements are used when heavy menstrual bleeding leads to anaemia and fatigue.
4. Uterine artery embolisation (UAE), a minimally invasive procedure, is used to reduce the blood supply to abnormal uterine tissue.
5. Endometrial ablation is used to destroy the uterine lining to reduce bleeding.

Adenomyosis can be an extremely painful condition to live with. Upon experiencing pain or noticing any other symptoms, it is important to consult with a healthcare provider for early diagnosis and adenomyosis treatment. For diagnosis, schedule a Pelvic Doppler test through the Dr Lal PathLabs app today.

Frequently Asked Questions

1. Is adenomyosis a serious problem?
   Adenomyosis is not a life-threatening condition, but it can become serious when symptoms are severe or left untreated. Persistent pain and heavy menstrual bleeding may lead to anaemia, fatigue, and a reduced quality of life.
2. What to avoid with adenomyosis?
   Foods high in fat, refined sugar, caffeine, and alcohol may worsen inflammation and menstrual discomfort. Activities that increase pelvic strain or stress may also aggravate symptoms and are often advised to be limited.
3. At what age is adenomyosis most common?
   Adenomyosis is most commonly diagnosed in women between 35 and 50 years of age, particularly in those who have had one or more pregnancies or previous uterine procedures.
4. What is the difference between adenomyosis vs endometriosis?
   In adenomyosis, endometrial tissue grows into the wall of the uterus. In endometriosis, similar tissue grows outside the uterus, such as on the ovaries or pelvic organs.