Adenomyosis: Symptoms, Diagnosis, and Treatment Options
for This Common Yet Misunderstood Disease

Adenomyosis is a disease that affects many women, yet it's often misunderstood or overlooked. In this blog post, we'll explore what adenomyosis is, how it differs from endometriosis, its symptoms, diagnosis, treatment options, and its impact on fertility.

What Is Adenomyosis?

Adenomyosis is considered endometrial tissue, meaning it is tissue similar to the lining of the uterus, but in this case, it grows abnormally into the muscular wall of the uterus itself, rather than outside the uterus as in endometriosis; essentially, it's the same tissue that lines the uterus, just in the wrong location within the uterine wall.

Common Symptoms of Adenomyosis:

- Heavy and prolonged menstrual bleeding

- Severe menstrual cramps

- Chronic pelvic pain

- Pain during intercourse

- Bloating and abdominal pressure

- Infertility in some cases

How Is Adenomyosis Different from Endometriosis?

While adenomyosis and endometriosis are related conditions, they have key differences:

1. Location: In adenomyosis, the endometrial tissue grows into the uterine muscle. In endometriosis, the tissue grows outside the uterus[2].

2. Organ Affected: Adenomyosis only affects the uterus, while endometriosis can involve other pelvic organs and even areas outside the pelvis.

3. Diagnosis: Adenomyosis is often diagnosed through imaging studies, while endometriosis typically requires laparoscopic surgery for definitive diagnosis[3].

The Relationship Between Adenomyosis and Endometriosis

Many women wonder about the connection between these two conditions. Here are some key points:

- Coexistence: Studies suggest that about 20-80% of women with endometriosis also have adenomyosis[4]. The wide range is due to variations in diagnostic criteria and methods.

- Independent Conditions: Having adenomyosis doesn't necessarily mean you have endometriosis, and vice versa. They are separate conditions, although they can occur together.

Diagnosing Adenomyosis

Diagnosing adenomyosis can be challenging, but several methods are used:

1. Transvaginal Ultrasound: This is often the first-line imaging test used to detect adenomyosis[5].

2. Magnetic Resonance Imaging (MRI): MRI can provide more detailed images and is considered the most accurate non-invasive method for diagnosing adenomyosis[6].

3. Hysteroscopy: This procedure allows doctors to view the inside of the uterus, which can help in diagnosis.

4. Biopsy: A definitive diagnosis can only be made through a biopsy of the uterine wall, typically done after a hysterectomy.

Treatment Options for Adenomyosis

Treatment for adenomyosis depends on the severity of symptoms and whether future fertility is desired. Options include:

1. Medications: NSAIDs for pain relief, hormonal treatments to control heavy bleeding[7].

2. Minimally Invasive Procedures: Uterine artery embolization or endometrial ablation for symptom relief[8].

3. Hysterectomy: This is considered a last resort and is only recommended when other treatments have failed and fertility is no longer desired[9].

It's important to note that being diagnosed with adenomyosis does not automatically mean you will need a hysterectomy. Many women manage their symptoms effectively with other treatments.

Adenomyosis and Fertility

Adenomyosis can affect fertility, but its impact varies:

- Some studies suggest adenomyosis may reduce fertility rates and increase the risk of miscarriage[10].

- The condition may interfere with embryo implantation and development.

- However, many women with adenomyosis can still conceive and carry pregnancies to term.

- Fertility treatments, such as IVF, can be successful for women with adenomyosis who are trying to conceive[11].

Adenomyosis is a complex disease that can significantly impact a woman's quality of life. While it shares some similarities with endometriosis, it's a distinct condition with its own set of challenges. If you're experiencing symptoms of adenomyosis, it's important to consult with a gynecologist for proper diagnosis and treatment. Remember, with the right care and management, many women with adenomyosis lead healthy, fulfilling lives.

References

[1] © 1998-2024 Mayo Foundation for Medical Education and Research (MFMER).

[2] Leyendecker, G., Bilgicyildirim, A., Inacker, M., et al. (2015). Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Archives of Gynecology and Obstetrics, 291(4), 917-932.

[3] Champaneria, R., Abedin, P., Daniels, J., et al. (2010). Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstetricia et Gynecologica Scandinavica, 89(11), 1374-1384.

[4] Di Donato, N., Montanari, G., Benfenati, A., et al. (2014). Prevalence of adenomyosis in women undergoing surgery for endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 181, 289-293.

[5] Dueholm, M. (2017). Minimally invasive treatment of adenomyosis. Best Practice & Research Clinical Obstetrics & Gynaecology, 40, 119-137.

[6] Novellas, S., Chassang, M., Delotte, J., et al. (2011). MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. American Journal of Roentgenology, 196(5), 1206-1213.

[7] Osada, H. (2018). Uterine adenomyosis and adenomyoma: the surgical approach. Fertility and Sterility, 109(3), 406-417.

[8] de Bruijn, A. M., Smink, M., Lohle, P. N., et al. (2017). Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. Journal of Vascular and Interventional Radiology, 28(12), 1629-1642.

[9] Pontis, A., D'Alterio, M. N., Pirarba, S., et al. (2016). Adenomyosis: a systematic review of medical treatment. Gynecological Endocrinology, 32(9), 696-700.

[10] Younes, G., & Tulandi, T. (2017). Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. Fertility and Sterility, 108(3), 483-490.

[11] Vercellini, P., Consonni, D., Dridi, D., et al. (2014). Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Human Reproduction, 29(5), 964-977.