Adenomyosis: Symptoms, Causes & Treatment

Adenomyosis is a condition where cells from the inner lining of the uterus, called the endometrium, grow into the muscular wall of the uterus, known as the myometrium. This abnormal growth can cause the uterus to become enlarged and lead to symptoms such as bloating, heavy or prolonged menstrual bleeding, and severe menstrual cramps.

The causes of adenomyosis aren’t fully understood, but it’s believed the condition can develop after gynecologic surgeries or a C-section, since these procedures can disrupt the deeper layers of the endometrium and myometrium.

Treatment for adenomyosis is managed by a gynecologist and may include anti-inflammatory medications, hormone therapy, or surgery to remove the uterus, depending on the severity of symptoms.

Adenomyosis symptoms

The main symptoms of adenomyosis include:

• Abdominal bloating;

• A feeling of pressure or heaviness in the abdomen;

• Heavy menstrual bleeding;

• Prolonged periods;

• Severe menstrual cramps;

• Sharp pelvic pain during menstruation;

• Chronic pelvic pain;

• Pain during sex (dyspareunia);

• Infertility.

Adenomyosis does not always cause symptoms. However, when symptoms do occur, they often appear two to three years after childbirth, even in women who may have had the condition since childhood. The symptoms typically go away after menopause, when menstrual cycles stop.

In addition, adenomyosis can contribute to painful periods (dysmenorrhea) or abnormal uterine bleeding, and it is often difficult to diagnose because its symptoms are similar to other uterine conditions.

Can adenomyosis affect pregnancy?

Adenomyosis can increase the risk of pregnancy complications, such as ectopic pregnancy, miscarriage, or preterm birth. For this reason, regular monitoring by an OBGYN is recommended to help prevent these complications.

In some cases, adenomyosis can make it more difficult for an embryo to implant in the uterus, which can lead to challenges with getting pregnant.

Confirming a diagnosis

A diagnosis of adenomyosis is made by a gynecologist based on symptoms such as pelvic pain, heavy menstrual bleeding, or difficulty becoming pregnant, as well as the person’s medical history and a pelvic exam.

To confirm the diagnosis, the doctor may order imaging tests such as a transvaginal ultrasound or magnetic resonance imaging (MRI), which can show thickening of the uterine wall.

A saline infusion sonohysterography may also be recommended, as it allows the doctor to view the inside of the uterus more clearly. This test helps identify adenomyosis and distinguish it from other conditions that can appear similar on ultrasound or MRI, such as endometriosis, fibroids, or cancer.

Possible causes

The causes of adenomyosis are not fully understood, but it is believed that uterine trauma, inflammation, genetic factors, and hormonal influences may lead to the abnormal growth of endometrial cells within the myometrium.

Factors that may increase the risk of developing adenomyosis include:

• Age (most common between 40 and 50 years old);

• Having more than one pregnancy;

• Cesarean delivery;

• Uterine dilation and curettage (D&C);

• Surgery to remove fibroids;

• Endometriosis;

• First period (menarche) before age 12;

• Short menstrual cycles;

• Overweight or obesity;

• Use of hormonal birth control pills;

• Use of tamoxifen.

Although the exact cause of adenomyosis is unknown, exposure to the hormone estrogen is known to play an important role in its development.

Can adenomyosis turn into cancer?

Adenomyosis is a benign (noncancerous) uterine condition. It is not related to cancer and does not turn into cancer.

Treatment options

Treatment for adenomyosis depends on the severity of symptoms and should always be guided by a gynecologist.

The main treatment options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to relieve pain and inflammation;

• Hormonal treatments, such as progesterone-only birth control pills, danazol, hormonal patches, vaginal rings, or hormonal IUDs (such as the Mirena IUD);

• Surgery to remove excess endometrial tissue when adenomyosis is localized in a specific area and not deeply embedded in the muscle;

• Hysterectomy (surgical removal of the uterus), which is generally reserved for severe cases when symptoms are constant, bleeding is heavy, and pregnancy is no longer desired.

A hysterectomy completely eliminates adenomyosis symptoms and is typically considered when other treatments have not worked or when the person does not plan to become pregnant. In most cases, the ovaries are not removed during the procedure.

Adenomyosis vs endometriosis

Adenomyosis and endometriosis both involve the growth of endometrial tissue outside its usual location. Adenomyosis is when endometrial tissue grows into the muscular wall of the uterus, while endometriosis refers to the growth of endometrial tissue outside the uterus, such as on the ovaries, fallopian tubes, or pelvic cavity.

Some women may have both adenomyosis and endometriosis at the same time, which can make symptoms more severe and diagnosis more complex.

There are two main types of adenomyosis: focal adenomyosis, when the abnormal tissue is confined to one area of the uterus, and diffuse adenomyosis, when the tissue spreads throughout the uterine wall, making the uterus larger and heavier.