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Upset Stomach

ADENOMYOSIS

 

Adenomyosis (pronounced AD - UH - NO - MY - O - SIS) is when the endometrium (the lining of the uterus) grows into the muscle tissue of the uterus causing an enlarged uterus and heavy, painful periods.

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Symptoms of Adenomyosis

  • Enlarged uterus​

  • Bloated abdomen

  • Heavy and long menstrual bleeding

  • Bleeding between periods

  • Period pain that stops you

  • Leg pain

  • Back pain

  • Hip pain

  • Pain during or after intercourse

  • Fertility problems

  • Constant tiredness

  • Painful cervical smear tests

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Causes of Adenomyosis

There are a number of theories:

  • Invasive tissue growth: Direct invasion of the endometrial tissue cells, perhaps during a Caesarean section (C-Section).

  • Developmental origins: From endometrial tissue displaced during the development of the foetus.

  • Uterine inflammation related to childbirth: From inflammation of the uterine lining after childbirth

  • Stem cell origins: A more recent theory proposing bone marrow stem cells invade the uterine muscle.

 

Diagnosing Adenomyosis

The only definitive way to diagnose adenomyosis is an examination and biopsy of the uterus AFTER hysterectomy, however, this is a significant surgery and not right for everyone.

 

Adenomyosis can be clinically diagnosed by:

  • MRI: an enlarged or 'bulky' uterus can show on an MRI

  • Laparoscopy: during a laparoscopy, an enlarged or 'bulky' uterus can be visualised. Adenomyosis in the uterus may also be seen

  • Transvaginal ultrasound: an enlarged and tender uterus can be seen on transvaginal ultrasounds

  • Pelvic exam: may also reveal an enlarged and tender uterus

 

Treatment and Management of Adenomyosis

Treatment options for adenomyosis include:

  • Hormonal treatments - may control some symptoms such as heavy or painful periods, options include progestin-only contraceptives and medications, combined oral contraceptives or GnRH analogues. The Mirena IUD can also reduce bleeding, and pain and shrink the uterus and adenomyosis by thinning the endometrial cells.

  • Pain relief - anti-inflammatory medications can be prescribed by your doctor which may work to relieve mild pain.

  • Endometrial ablation - this is used to burn or remove the lining of the uterus. This has been found to be effective in relieving symptoms in some patients where adenomyosis hasn't penetrated deeply into the muscle wall of the uterus (less than 2.5mm deep) and also is not suitable if wanting to be pregnant.

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