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. It is, essentially, endometriosis of the uterus. Pain associated with adenomyosis can be debilitating and persistent, even after surgical removal of endometrial tissue.
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.
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:
Adenomyosis appears to be more common in women who have had children, then those who have not. This relationship may be biased, given that adenomyosis is typically diagnosed at the time of hysterectomy. Prior uterine surgery, such as a cesarean section or fibroid removal (myomectomy) may also be a risk factor for developing adenomyosis.
Adenomyosis is a histological diagnosis, meaning that the uterus has to be sent for pathological evaluation after hysterectomy. There are clinical manifestations, such as heavy menstrual bleeding or centralized pelvic pain, as well as imaging findings on MRI or ultrasound that can give a clinical diagnosis. However, definitive diagnosis is made after a hysterectomy.
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:
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.
There is little evidence regarding preventative measures to avoid adenomyosis. However, maintaining a healthy lifestyle and using hormonal contraceptives may be associated with a decrease in symptoms from adenomyosis.
Complications such as heavy bleeding can lead to anemia and if severe, may require a blood transfusion. Persistent pelvic pain or painful periods can disrupt and negatively affect one’s quality of life.
“Pure adenomyosis” is often rare, given that adenomyosis is essentially endometriosis of the uterus. Pelvic endometriosis often times will co-exist with uterine adenomyosis and contribute to pelvic pain. There have been studies that women with adenomyosis may be at a higher risk of developing certain cancers, particularly endometrial and thyroid cancers. More research is needed to fully investigate this relationship.