Adenomyosis

What is adenomyosis?

Adenomyosis is a medical condition in which the endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus (the myometrium).  This results in the thickening of the uterine wall and lead to enlargement of the uterus. 

What causes adenomyosis?

The exact cause of adenomyosis is not fully understood, but it is thought to be related to hormonal imbalances and inflammation.

 What are the symptoms of adenomyosis?

  • Heavy or prolonged menstrual bleeding

  • Pelvic pain or discomfort

  • Menstrual cramps

  • Spotting (bleeding) between periods

  • Pain during sex

  • Abdominal tenderness

More information about adenomyosis

How is adenomyosis diagnosed?

The symptoms of heavy menstrual bleeding and period pain usually raise suspicion. 

The uterus may be enlarged and tender on internal examination. 

A pelvic ultrasound will also show features of a “globular” uterus with a thickened muscular wall.  Definitive diagnosis can only be made after a hysterectomy (surgical removal of the uterus) and examination of the uterine tissue.

What are the treatment options?

Treatment options for adenomyosis depend on the severity of symptoms, age, and desire for future fertility.  For pain symptoms non-steroidal anti-inflammatory drugs (NSAIDS) are very effective.  Tranexamic acid can also help with reducing heavy menstrual bleeding. 

The next step would be with hormonal therapy, options include:

  • Progesterone only tablets ie. Slinda

  • Combined oral contraceptive pill (oestrogen and progesterone)

  • Intra uterine device (IUD) ie. Mirena (which releases progesterone only)

Out of all the hormonal agents the mirena is very effective as it is localised to the uterus and can help reduce both pain and bleeding symptoms.

If these options were to fail the next step would be with surgery.  Endometrial ablation is very effective with reducing the amount of blood loss from heavy periods but may not cure the pain component.  If pain was a factor and conservative measures have failed, hysterectomy would be a definitive and valuable treatment option in women who have completed their childbearing.

If I have adenomyosis what is my chance of me also having endometriosis?

20-50% of patients who with adenomyosis also have been found to have endometriosis.