Similar to endometriosis, adenomyosis uteri, or just adenomyosis, is the presence of ectopic endometrial tissue in the muscle layer of the uterus without a direct connection to the endometrium. Pain associated with adenomyosis can be debilitating and persistent, even after surgical removal of endometrial tissue.
What causes adenomyosis?
At present, it isn’t known what causes adenomyosis. There are a few theories, with the most prominent being that the endometrial cells are somehow able to move and invade the normal uterine wall. Another theory is that the existing cells in the uterine wall change and develop into endometrial cells.
What are some adenomyosis symptoms?
Adenomyosis develops from aberrant glands of the endometrium and causes pain before, during and after menses. In addition, women may suffer from heavier menses (menorrhagia), discomfort after orgasm, and vigorous exercise. Some women experience intense pelvic cramping and pressure that radiates to the lower back, groin, rectum, and anterior thighs. Symptomatic adenomyosis usually is manifested in women aged 35 to 50 years, although adenomyosis can be found in asymptomatic women. Women may experience symptomatic adenomyosis because of family history and genes.
There appear to be wide variations in the incidence of adenomyosis between racial and ethnic groups and different geographic regions. It is not clear whether this is due to patient factors or differences in diagnosis. As the ectopic endometrial tissue proliferates, the uterus takes on an enlarged, globular shape, which can sometimes be appreciated on examination typically in conjunction with marked tenderness.
Adenomyosis symptoms include:
- prolonged menstrual cramps
- spotting between periods
- heavy menstrual bleeding
- longer menstrual cycles than normal
- blood clots during menstrual bleeding
- pain during intercourse
- tenderness in the abdominal area
What are the treatment options for adenomyosis pain?
Adenomyosis isn’t necessarily harmful. However, the symptoms can negatively affect your lifestyle. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities such as sexual intercourse. Treatments to reduce adenomyosis pain include:
- anti-inflammatory medications
- hormonal treatments
- ultrasound-guided trigger point injections
- endometrial ablation
- uterine artery embolization
- MRI-guided focused ultrasound surgery (MRgFUS)
Pelvic Rehabilitation Medicine always recommends beginning with a more holistic and conservative approach to treating pain. Pelvic floor muscle dysfunction and pelvic pain can be triggered by adenomyosis and these patients may benefit from our Pelvic Rehabilitation Medicine’s approach.