Causes, Symptoms, and Treatment Options

Adenomyosis

Affecting 20-35% of women, pain and symptoms associated with adenomyosis can overlap with endometriosis and even co-exist with the condition, but adenomyosis is caused by invasive growth of endometrial-like tissue into the uterus.

 

Understanding Adenomyosis

What is Adenomyosis?

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.

 

Symptoms of Adenomyosis

While the severity of chronic pelvic pain symptoms range, symptoms are usually related to gynecologic, urologic, gastrointestinal, and musculoskeletal conditions and exhibit a wide range of symptoms in both women and men.

 

Symptoms of Adenomyosis

What Causes Adenomyosis?

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.

 

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    Prolonged menstrual cramps

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    Spotting between periods

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    Heavy menstrual bleeding

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    Blood clots during menstrual bleeding

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    Pain during intercourse

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    Tenderness in the centralized abdominopelvic area

Adenomyosis

Risk Factors

Because the causes of adenomyosis are not fully known, medical professionals are not exactly sure of the risk factors, but data shows us these risk factors may include:

 

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    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.

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    Prior uterine surgery, such as a cesarean section or fibroid removal.

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    There appears 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.

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    Symptomatic adenomyosis usually is manifested in women aged 35 to 50 years, although adenomyosis can be found in asymptomatic women.

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    Women may experience symptomatic adenomyosis because of family history and genes.

Do You Think You Have Adenomyosis?

Diagnosing Adenomyosis

While diagnosing adenomyosis definitively requires a histological diagnosis, meaning that the uterus has to be sent for pathological evaluation after hysterectomy, our team can also use additional modes to provide a suspected diagnosis.

Here’s what you can expect when you are a patient at Pelvic Rehabilitation Medicine:

 

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    Step One – First, our providers will ask questions about your medical history and listen to your symptoms to get a full picture of what is going on with you.

     

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    Step Two – Next, an external exam of your hips, abdomen, and posterior sacrum.

     

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    Step Three – Next, your pelvic nerves are evaluated externally with a soft cotton tip.

     

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    Step Four – Next, with your consent, gel is placed on a gloved finger and an internal exam is performed to allow us to evaluate the nerves and muscles within the pelvis. There is no speculum required as we are evaluating the pelvic floor muscles and nerves not the organs.

     

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    Step Five – Sometimes patients will need Imaging to help us understand if there is an associated cause of the pelvic nerve and muscle pain and dysfunction found on exam.

     

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    Step Six – Oftentimes, treatment can be started the same day as there is no down time. Our patients have been suffering with pelvic pain symptoms for 6+ months. We like to get them on the road to feeling better as soon as we can as the longer the symptoms are present the harder it is for us to resolve them.

     

Treatment Options for Adenomyosis

Adenomyosis isn’t necessarily harmful. However, the symptoms can negatively affect your quality of life. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities such as sexual intercourse. A surgical Hysterectomy is a definitive treatment for Adenomyosis. However, many patients do want a hysterectomy particularly if they want to have children in the future they are looking to preserve their Uterus. Therefore, at PRM we offer a proprietary office-based procedure to treat the symptoms of adenomyosis for those looking to avoid a hysterectomy. This treatment consists of a series of pelvic nerve and muscle treatments to directly target spastic pelvic floor muscles, inflammation in the pelvis, and nerve pain. Depending on the patient’s individual presentation, other modalities may be needed in addition to our treatment.

  • Anti-inflammatory medications
  • Medications directed at the nervous system
  • Medications directed at the bladder
  • Hormonal treatments
  • Uterine artery embolization
  • MRI-guided focused ultrasound surgery (MRgFUS)
  • Hysterectomy – At PRM, we are proud to have world-renowned Endometriosis Excision Surgeons who specialize in conditions such as adenomyosis and endometriosis, should an operative approach such as a hysterectomy be a patient’s choice.

 

Frequently Asked Questions

Experiencing chronic pelvic pain can be debilitating and discouraging, but our team of pelvic pain specialists will listen to you, validate your experiences and symptoms, and partner with you on your rehabilitation journey.

 

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 oftentimes will coexist 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.

“Pure adenomyosis” is often rare, given that adenomyosis is essentially endometriosis of the uterus. Pelvic endometriosis oftentimes will coexist with uterine adenomyosis and contribute to pelvic pain. With adenomyosis, abnormal tissue grows into the uterine muscle. While both cause pelvic pain and often menstrual symptoms, endometriosis is when tissue similar to the lining of the uterus grows outside the uterus.

We recommend scheduling an appointment with our team if any of the symptoms you are experiencing are affecting your quality of life and desired daily function.

You’ll meet with one of our pelvic pain specialists, who focus solely on pelvic pain. We’ll start with reviewing your full health history, including a discussion of your symptoms. This will help us to understand what you’ve been experiencing, so we can work to identify the source of your pain.
Next, we’ll conduct a full pelvic exam. Externally, we will look at your hips, abdomen, and posterior sacrum. Internally, we will evaluate the nerves and the muscles within the pelvic area. This full exam is necessary , as it will help our pelvic pain specialists understand the connection between your symptoms, and your nerve and muscle pain and dysfunction. There is no speculum, so the exam is gentle and more comfortable than that of, for example, gynecological exams you may have experienced in the past.
We will discuss our findings with you and come up with a comprehensive treatment plan TOGETHER. We want you to know that your pain is validated and that we are here to work with you on getting you back to the life you deserve.

Experience Relief From Adenomyosis.