Adenomyosis is a thickening of the uterus. It occurs when the endometrial tissue spreads to the outer walls of the uterus. This tissue usually upholstery the womb.
Description
Endometrial tissue makes up the lining of the uterus. It responds to hormones and bleeds during periods. In adenomyosis, some endometrial tissue spreads inside the walls of the womb.
It may sometimes form a significant growth (adenomyoma), but such a tumour is not cancerous.
More often than not, the endometrial tissue is spread out in the walls of the womb. The muscle still bleeds during periods, which produces many of the symptoms.
Adenomyosis affects 1 percent of women, mainly when they are over 40 and have had more than one birth.
It is important to note that adenomyosis is not the same as endometriosis, however, on more than 10% of the occasions this disease accompanies it.
Although some cases of adenomyosis do not affect fertility, this condition may interfere with the transport of sperm or obstruct the process of implantation of the embryo.
Symptoms
In addition to analysing the patient’s medical history, procedures for diagnosing coronary heart disease include:
A pelvic exam may reveal a uterus two or three times bigger than usual, as well as the presence of an adenomyoma.
A transvaginal ultrasound or gynaecological vaginal ultrasound during which the doctor inserts a tube into the woman’s vagina to examine her uterus.
Transvaginal ultrasound is a painless and straightforward procedure, and it usually allows for precise diagnosis.
However, in some cases, medical experts require additional tests for further analysis. An MRI can be useful when the ultrasound does not yield definitive results
Because conditions such as endometriosis, Uterine Myomatosis and Uterine Polyps can get confused with adenomyosis, it is essential that the tests be interpreted by an experienced specialist, who will get the maximum information from each procedure.
In many cases, the woman may not have any symptoms. When symptoms do occur, they may include:
- Heavy or prolonged menstrual bleeding.
- Painful menstruation, progressively worse.
- Pelvic pain during sexual intercourse.
- Painful or heavy periods: Many other conditions can give these symptoms, but if they start in a middle-aged woman who has previously been ok (and has also had children), adenomyosis is a likely cause.
- Severe cramps and contractions may occur during periods.
- Pain during sexual intercourse.
- Abdominal cramps or bloating along with back pain, and nausea.
Adenomyosis can lead to complications during pregnancy, including an increased risk of miscarriage.
Ultrasound or magnetic resonance scanning can be used to diagnose adenomyosis, and tell it apart from similar conditions, such as fibroids or cancerous tumours.
Any woman who displays most of these symptoms should see a physician so that doctors make a definite diagnosis.
Causes
The cause is unknown. Sometimes, adenomyosis can cause a mass or a tumour inside the uterus.
Although the specific cause of adenomyosis is not known, its growth is associated with the hormonal activity of the ovaries and in particular with the production of estrogen.
Women over the age of 40 who have had more than one birth are more likely to develop adenomyosis, particularly if they undergo cesarean section or other uterine surgery.
The disease most often occurs in women aged 40 to 50 who have had at least one pregnancy.
Adenomyosis occurs when the tissue that makes up the lining of the womb (endometrial tissue) starts growing inside the muscular wall of the uterus.
It is not clear why some women get adenomyosis, and some do not. It tends to occur in women who have previously had children and are over 35 years of age.
Symptoms usually end once the patient reaches the menopause. Some medical experts had been suggesting that adenomyosis is related to the hormone estrogen.
In the cases of young women, progesterone counteracts the effects of estrogen. When women are in their thirties, progesterone levels start to decline.
Tests and Exams
The health care provider will make the diagnosis if a woman has symptoms of adenomyosis that are not caused by other problems.
The only way to confirm the diagnosis is to examine the uterine tissue after surgery to remove it.
During a pelvic exam, the provider may find a soft, slightly enlarged uterus. The test may also reveal a uterine mass or tenderness of the uterus.
The healthcare provider can perform An ultrasound of the uterus, but sometimes that cannot give a definite diagnosis of adenomyosis.
That is why several doctors find an MRI pretty useful when they suspect of the presence of other uterine tumours.
Treatments
Painkillers can be used to reduce the severity of the symptoms. People can take Ibuprofen or Acetaminophen (paracetamol).
Progesterone tablets can help lessen the symptoms and give lighter periods.
Most women have some adenomyosis as they approach menopause. However, only a few have symptoms. Most do not require any treatment.
Birth control pills and an IUD containing progesterone may help decrease heavy bleeding. Medications like ibuprofen or naproxen may also help manage the symptoms.
Doctors can perform surgery on women whose health is deteriorating because of the disease. They remove the uterus during this procedure.
The Levonorgestrel Intrauterine System (LNG-IUS) is a contraceptive implant that secretes the hormone levonorgestrel. It can be useful for relieving the symptoms of adenomyosis.
Gonadotropin-Releasing Hormone Analogs (GnRHas), such as goserelin and leuprolide, can shrink areas of adenomyosis.
These drugs decrease the levels of the female hormone estrogen and produce an artificial (but reversible) menopause.
They are not suitable for oral administration, so people need to get them administered by injection. Serious side-effects, such as bone thinning, can occur if people continually use the drugs for more than six months.
Sometimes healthcare providers give patients a female hormone, or a related analogue, to reduce side-effects such as hot flushes.
Uterine Artery Embolization (UAE) is a procedure carried out in hospital under local anaesthetic.
The arteries supplying blood to the uterus are blocked using microscopic particles. The reduced blood supply causes the areas of adenomyosis to shrink.
However, this technique is not as successful in treating adenomyosis as it is in treating fibroids.
Although a subsequent pregnancy is usually possible, there is some uncertainty about the effect of the procedure on fertility.
Patients should discuss this issue with their physicians if there is a possibility they may wish to get pregnant in the future.
Medical experts only resort to surgery when other methods fail. They can remove localised areas of adenomyosis, but in many cases, the adenomyosis spreads throughout the muscles of the womb. Under such circumstances, the patient may need a hysterectomy.
Expectations (prognosis)
In most cases, symptoms disappear after menopause. A hysterectomy completely relieves symptoms.