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Adenomyosis

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Introduction

Adenomyosis is a condition affecting the uterus. It causes the inner lining of the uterus to grow into the muscular layer. It occurs in the late menstrual age (40s and 50s) and disappears following menopause.

The uterus has an inner lining (endometrium), which every woman sheds during menstrual cycles.

In adenomyosis, the endometrium grows inside the muscular layer of your uterine wall (myometrium). The invading endometrial tissues behave ordinarily within the muscles – thickening, bleeding, and shedding – during the menstrual cycles. It enlarges the uterus and causes painful and heavy menstrual flow.

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What can cause adenomyosis?

The exact cause of adenomyosis remains unknown. However, plenty of theories speculate the reason for adenomyosis. These theories include:

  • Fetal growth

According to some experts, the endometrium encroaches into the uterine muscles as the fetus develops in the uterus.

  • Childbirth

During childbirth, the uterine lining can get inflamed. The inflammation can cause a breach of the structure of your uterus. It can cause the endometrium to migrate deeper into the walls.

  • Traumatic invasion

Trauma to the uterus, such as incisions made in the walls during surgeries involving the uterus, is another theory for causing adenomyosis. The incisions promote the inner lining to invade into the muscles as healing occurs.

  • Stem cell

Some experts believe the bone marrow cells proliferate into the wall and exist within, causing symptoms.
Irrespective of the cause of adenomyosis, the symptoms depend on estrogen levels in your body. It is the reason why it occurs predominantly at late menstrual ages, as the hormonal exposure is higher.

What are the symptoms of adenomyosis?

Adenomyosis can display mild discomfort or even no signs or symptoms in some women. However, typically if you have adenomyosis, you will experience the following symptoms:

  • ● Prolonged period
  • ● Heavy flow during periods
  • ● Severe abdominal cramping and pain
  • ● Pain during intercourse
  • ● Enlarged uterus
  • ● Tenderness on the lower abdomen

How to diagnose adenomyosis?

The symptoms of adenomyosis are common and, therefore, similar to several uterine disorders. Diagnosing adenomyosis from other diseases such as endometriosis, uterine tumors, and fibroids is problematic. Your doctor will take a detailed medical history and evaluate symptoms to exclude all other conditions.

Imaging studies such as MRI and ultrasound scans may detect signs of adenomyosis.

Your doctor may also advise a biopsy study of the uterine lining in case of heavy bleeding to rule out severe conditions. However, a biopsy cannot confirm the diagnosis of adenomyosis.

The only means of a definitive diagnosis is through a uterus exam following hysterectomy (surgical removal of the uterus).

How is adenomyosis treated?

Adenomyosis often disappears after menopause. The treatment for adenomyosis depends on the severity of your symptoms and your menstrual age.

  • Pain relievers

Anti-inflammatory drugs can manage your pain symptoms during the menstrual cycles. Your doctor can prescribe to take these medicines a few days before and during the period to help control the pain.

  • Hormonal replacements

Hormonal replacement drugs can reduce the menstrual flow and also help with pain during menstrual cycles. A combination of estrogen-progestin oral contraceptive pills is a popular choice to relieve the symptoms. Intrauterine devices can also provide a hormonal replacement. These treatments help regulate the estrogen levels to manage your symptoms.

  • Ablation therapy

Ablation therapy is a technique that removes the endometrial lining of your uterus. It can reduce the menstrual flow, even stopping the flow altogether in some cases. It is not always effective as the endometrium exists within the muscle layer in adenomyosis.

  • Hysterectomy

In severe cases, the bleeding can cause chronic anemia and other life-threatening medical conditions. Hysterectomy is the only cure available for adenomyosis in such cases.

What is the result?

Most cases resolve on their own with menopause. Menopause stops the changes occurring in the endometrium with each menstrual cycle, thereby prevents symptoms.

In extreme cases with severe bleeding, there is a health risk due to blood loss. A hysterectomy may be the only curative option in such cases.

What are the risks of surgery?

Hysterectomy may cure adenomyosis, but it has risks and side effects like any other surgery. The surgery can put you at risk of:

  • ● Infection
  • ● Excessive blood loss
  • ● Reaction to anesthesia.

 

In the long term, loss of the uterus can cause:

  • ● Prolapse of the pelvic floor
  • ● Loss of control over urine, involuntary leakage
  • ● Bowel incontinence
  • ● Difficulties with intercourse
  • ● Hormonal imbalance

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FAQ's

Is Adenomyosis Painful?

Yes, Adenomyosis can be painful, especially during periods and intercourse. The invading endometrial tissues swell and bleed within the muscle layer of your uterus during the period. It causes pain and cramps.

Is Adenomyosis the Same as Endometriosis?

Adenomyosis differs from endometriosis. In endometriosis, the tissue similar to the uterine lining grows and exists outside of your uterus. Adenomyosis shows the growth of the inner lining invading the muscle layer of the uterus. Women with Adenomyosis may also have endometriosis.

Is Adenomyosis Serious?

The symptoms of Adenomyosis can impact your life. The severe cramping and pain, along with heavy bleeding, can stop you from doing your daily activities. Some women also experience difficulties in their sex life.
Severe blood loss during periods can put you at risk of developing chronic anemia.

What is the Best Treatment for Adenomyosis?

Often, the symptoms of Adenomyosis disappear after menopause. Although there are medications available for managing the symptoms, hysterectomy (removal of the uterus) is the only definitive cure.

Can I Get Pregnant with Adenomyosis?

Adenomyosis can disrupt your life and interfere with your ability to become pregnant. The likelihood of miscarriages and infertility is higher in women with Adenomyosis.

Can Exercising Help with Adenomyosis?

Several studies indicate exercising can be beneficial in relieving the symptoms of pain during Adenomyosis.

Can Adenomyosis Worsen?

Adenomyosis is progressive, and symptoms can worsen if left untreated. The symptoms, however, disappear after menopause.

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