Adenomyosis: What You Need to Know

Adenomyosis: What You Need to Know

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Having an OB/GYN provider that you are comfortable with is the first step in ensuring your reproductive health. Being able to engage in conversations that might seem uncomfortable with a caring and supportive physician makes it easier to discuss the changes you are experiencing in your body. Starting with puberty, the female body experiences many changes over the course of time, and some of the monthly experiences with ovulation or your menstrual cycle can bring concerning side effects or discomforts.

Not knowing if the changes are normal might be alarming, but often women are embarrassed to talk about what they are experiencing. By being honest and open with your OB/GYN about the details of pains, discomfort, discharges, or flow of your cycle, your provider is able to help diagnosis conditions that are abnormal and causing harm to your uterus, cervix and reproductive organs. One such condition is adenomyosis.

Who is affected?
Often occurring in women over the age of 35 and who have had a least one child, adenomyosis (ad-uh-no-my-O-sis) is not a life-threatening condition but one that can severely impact fertility. About 1 in 100 women will experience the condition, and the pain and discomfort associated with adenomyosis affects a woman’s quality of life. There haven’t been any official labels for what causes adenomyosis, but studies and physicians have found that it typically disappears after menopause.

What is it?
Adenomyois is endometriosis of the uterine muscle. The endometrial tissue is supposed to line the walls of the uterus, but in adenomyosis, the endometrial lining grows into the uterine muscle wall itself.  The abnormal cells still grow and act like endometrial tissue and maintain their original menstrual cycle schedule of thickening and breaking down and bleeding, but now it occurs within the uterine wall. This leads to an enlarged uterus and extremely painful periods.
There are three types of adenomyosis: focal adenomyosis, a focal adenomyoma, and diffuse adenomyosis. Focal adenomyosis is on one particular site of the uterus; adenomyoma is form of focal but results in a mass or benign (non-cancerous) tumor; diffuse is adenymosis spread throughout the uterus.

What are the symptoms?
Symptoms for adenomyosis might be similar to uterine fibroids or endometriosis, but the conditions are not the same. If you are experiencing any of the following or are having trouble getting pregnant, it is important to speak with your OB/GYN about your menstrual history and symptoms.

  1. Painful cramping and heavy bleeding during your period
  2. Passing blood clots during menstruation
  3. Unexplained bleeding between your periods
  4. Pain during sex, especially around the time of your period
  5. Swelling or tenderness in your lower belly (uterine swelling)

How is it treated?
Ultrasounds, MRI’s, and pelvic exams are the most often used tests to determine the presence of adenomysis. Your provider will know the best diagnostic process as you relay your symptoms and concerns. Treatment for the condition is varied, and takes into account symptoms, their severity, and if you done having children. Mild symptoms may be treated with over-the-counter pain medications often associated with menstrual cycle conditions, while more severe symptoms such as heavy or painful periods may be controlled with hormonal therapies however, hormonal therapy usually fails with adenomyosis. There are a few minimally invasive procedures designed to remove the adenomyosis tumors or harmfully growing tissues (laparoscopic deep excision surgery, uterine artery embolization, endometrial ablation) when the condition has not grown throughout the uterus. More severe cases where the adenomyosis has diffused throughout the uterine wall are often only resolved through a hysterectomy (either full or partial). A hysterectomy is usually a last resort treatment option.

As you understand your body’s changes, be mindful of anything that seems abnormal. If you are struggling with fertility or heavy and painful periods, be prepared to talk openly with your doctor about symptoms or changes you have noticed causing discomfort, pain, or unease. Your OB/GYN is ready to listen and has the knowledge and tools to address your concerns. If you have adenomyosis, medical and surgical treatment options may help to restore your fertility and improve your quality of life.

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