In adenomyosis, the endometrial tissue that lines the uterus grows into the muscle of the uterus.
This condition makes the uterine walls thicker and distorts the vasculature (blood vessels), which can lead to heavy, prolonged, and painful periods. Adenomyosis is also associated with pain during sexual intercourse, as well as infertility.
Adenomyosis is believed to be estrogen-dependent or hormone-sensitive. It usually disappears after menopause, which takes place 12 months after a person’s final menstrual period. Menopause is also when estrogen levels decline.
Symptoms of this condition can be mild to severe. Some people may not experience any at all.
The most common symptoms include:
- heavy or prolonged menstrual bleeding
- painful menstrual cramps
- blood clots during menstrual bleeding
- pain during sexual intercourse
The exact cause of adenomyosis is unknown.
There are several theories about what causes this condition. They include:
- invasive growth of endometrial cells into the uterine muscle — this may be due to an incision made in the uterus during surgery (like a cesarean delivery) or during normal uterine functioning
- uterine inflammation that occurs after childbirth — this may break the usual boundaries of the cells that line the uterus
- extra tissues in the uterine wall, which are present before birth and grow during adulthood
- stem cells in the myometrium, or uterine muscle wall
There are certain factors that put people at greater risk for the condition. These include:
- age, with most people diagnosed in their 30s or 40s, a smaller proportion diagnosed as early as their teens, and some diagnosed after the age of 50 years old
- having given birth before
- undergoing treatment with the breast cancer drug tamoxifen
Other risk factors that have been suggested, but are controversial or have fewer data to support them, include:
- having had uterine surgery, like a cesarean delivery or surgery to remove uterine fibroids
- a history of depression or antidepressant use
Diagnostic evaluation generally includes a physician exam and imaging. The doctor will want to perform a physical and pelvic exam to determine if your uterus is enlarged or tender to palpation. In some cases, people with adenomyosis can have a uterus that’s double or triple the normal size.
Imaging tests that may be performed include an ultrasound or MRI scan.
A transvaginal ultrasound can help the doctor diagnose the condition while also ruling out other causes of your symptoms. An ultrasound uses sound waves to produce moving images of your internal organs — in this case, the uterus.
For this procedure, the ultrasound technician (or sonographer) will cover the ultrasound probe with a condom, and then cover the condom with a liquid conductive gel.
Then, they’ll place the ultrasound probe inside your body. The probe will produce moving images on the screen to help the sonographer see your uterine and pelvic anatomy.
Making a diagnosis of adenomyosis by ultrasound can be challenging, and your doctor may recommend more advanced imaging.
The imaging test of choice for diagnosing adenomyosis is the MRI scan. An MRI uses a magnet and radio waves to produce high-resolution images of the internal organs.
On an MRI, there are distinct radiologic features of the uterus that will lead a healthcare professional to suspect adenomyosis. Examples include a thickening of the area between the endometrium (lining of the uterine cavity) and myometrium.
This procedure involves lying very still on a metal table that will slide into the scanning machine.
If you’re scheduled to have an MRI, be sure to tell the doctor if there’s any chance you’re pregnant. Also, tell the doctor and the MRI technician if you have any metal parts or electrical devices inside your body, like a pacemaker, piercings, or metal shrapnel from a gun injury.
People with mild forms of adenomyosis may not require medical treatment. The doctor may recommend treatment options if your symptoms interfere with your daily activities or quality of life.
Treatments aimed at reducing the symptoms of adenomyosis include the following:
Anti-inflammatory medications like ibuprofen (Advil, Motrin, Midol) can help to reduce blood flow during your period while also relieving severe cramps.
The doctor will advise you on how often to take these medications. One possible regimen involves taking anti-inflammatory medication 2 to 3 days before the start of your period and continuing to take it during your period.
If you’re pregnant, speak with a doctor before taking anti-inflammatory medications. Depending on your trimester, they may recommend that you avoid these medications.
Hormonal treatments can help to control the estrogen that may be contributing to your symptoms. They include:
- gonadotropin-releasing hormone (GnRH) analogs like leuprolide (Lupron)
- oral contraceptives like birth control pills
- progestin-only contraceptives like a pill, an injection, or an intrauterine device (IUD)
Endometrial ablation involves techniques to remove or destroy the endometrium. It’s an outpatient procedure with a short recovery time.
But this procedure may not work for everyone, since adenomyosis often invades the muscle more deeply. It’s only recommended for people who have completed childbearing or aren’t interested in getting pregnant.
Uterine artery embolization
Uterine artery embolization prevents certain arteries from supplying blood to the affected area. With the blood supply cut off, the adenomyoma shrinks. This procedure is typically used to treat uterine fibroids.
The procedure is performed in a hospital. It usually involves staying overnight afterward. Since it’s minimally invasive, it doesn’t cause scar formation in the uterus.
Ultrasound-guided focused ultrasound surgery
Ultrasound-guided focused ultrasound surgery uses precisely focused high-intensity waves to create heat and destroy the targeted tissue. The heat is monitored using ultrasound images in real-time.
The only way to completely cure adenomyosis is to have a hysterectomy, which involves the complete surgical removal of the uterus. It’s considered a major surgical intervention and is only used in severe cases and in people who don’t plan to give birth in the future.
Your ovaries have no effect on adenomyosis. You and your doctor will have a discussion about whether there are other reasons to either remove them (especially if you’re postmenopausal) or leave them in place.
Adenomyosis symptoms can negatively affect your lifestyle. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal activities like sexual intercourse.
The blood loss associated with adenomyosis can reduce iron levels in the body. Without enough iron, the body can’t make enough red blood cells to carry oxygen to the body’s tissues. This can cause fatigue, dizziness, and moodiness.
Adenomyosis isn’t typically life threatening, but it can be associated with severe bleeding.
Many treatments are available to help alleviate your symptoms. A hysterectomy is the only treatment that can eliminate them altogether. But the condition often goes away on its own after menopause.