Adenomyosis Definition, Reason, Symptoms, Diagnosis

Adenomyosis is a health condition that occurs when the tissue that lines the uterus or uterus (endometrium)

Definition

Adenomyosis is a health condition that occurs when the tissue that lines the uterus or uterus (endometrium) grows into the muscular wall of the uterus. The tissue continues to undergo the same cycle, namely thickening, shedding, and bleeding, during the menstrual cycle. This condition can cause an enlarged uterus, pain, and excessive menstrual bleeding.

The exact cause of adenomyosis is not known, but this condition generally stops after menopause. In women who experience excessive discomfort due to adenomyosis, hormonal treatment can help overcome complaints. Removal of the uterus is the definitive treatment for adenomyosis.

Reason

The exact cause of adenomyosis is not known. There are several theories that are thought to be involved in the occurrence of this condition, namely:

• Invasive tissue growth. Some experts believe that adenomyosis occurs as a result of direct invasion of endometrial cells from the outer layer of the uterus into the muscles that make up the uterine wall.

An incision in the uterus performed at the time of surgery, such as cesarean section, is thought to support a direct invasion of endometrial cells into the uterine wall.

• Growth process. Some experts suspect that adenomyosis begins in the uterine muscle where there is endometrial tissue that was already present when the uterus began to form in the fetus’s body.

• Inflammation of the uterus related to childbirth. Another theory related to this condition is that there is a link between adenomyosis and childbirth.

Inflammation of the lining of the uterus during the puerperium can cause gaps in the normal boundaries of the cells lining the uterus. Sometimes, surgical procedures on the uterus can have a similar effect.

• Stem cells. One recently developed theory suggests that stem cells from the bone marrow can invade the uterine muscle, causing adenomyosis.

Regardless of the onset of adenomyosis, its development depends on circulating estrogen in the woman’s body.

Some of the risk factors thought to be associated with adenomyosis are:

• History of previous surgical procedures on the uterus, such as a caesarean section or removal of fibroids
• Labor process
• Middle age

Symptoms

Sometimes, adenomyosis does not show certain signs and symptoms, or only very mild discomfort. However, in some cases, adenomyosis can cause:

• Excessive or prolonged menstrual bleeding
• Very heavy cramping or sharp pain in the pelvis during menstruation (dysmenorrhea)
• Chronic pelvic pain

The size of the uterus can increase in size. Although the patient may not be able to tell if the uterus is enlarged, the patient may feel pain in the lower abdomen or excessive pressure in the pelvis.

Diagnosis

The diagnosis of adenomyosis can be determined based on the results of a medical interview, physical examination, and certain investigations. Doctors can suspect adenomyosis based on the signs and symptoms experienced, the results of a pelvic exam that shows an enlarged and painful uterus, an ultrasound (USG) of the uterus, or a magnetic resonance imaging (MRI) result of the uterus.

In some cases, the doctor may also perform a sample of uterine tissue for further evaluation (endometrial biopsy) to ensure that the abnormal uterine bleeding is not related to another serious condition. However, endometrial biopsy alone is not performed to confirm the diagnosis of adenomyosis.

The way to confirm the presence of adenomyosis is to perform an examination of the uterus after a hysterectomy or removal of the uterus. However, imaging studies of the pelvis such as ultrasound and MRI can detect signs of adenomyosis.

Other diseases of the uterus can sometimes show signs and symptoms similar to adenomyosis, making the diagnosis of this condition more difficult to establish. Certain conditions of the uterus, such as fibroid tumors (leiomyomas), uterine cells that grow outside the uterus ( endometriosis ), and growths of tissue on the lining of the uterus (endometrial polyps), can have signs and symptoms that mimic adenomyosis.

Treatment

Adenomyosis often subsides after menopause, which makes treatment dependent on how far the individual with this condition is from that phase.

Some of the treatment options for adenomyosis include:

• Anti-inflammatory treatment. Doctors can prescribe the use of anti-inflammatory drugs to treat pain that arises. Generally, this drug will be recommended to be taken one to two days before menstruation begins and during menstruation.

• Hormonal treatment. Hormonal treatment with a combination of estrogen and progesterone can help relieve the excessive bleeding and pain associated with adenomyosis.

Medications containing only progestins often cause amenorrhoea, or the absence of menstruation, which can help relieve symptoms.

• If the pain is very severe and other treatments do not show any benefit, the doctor may recommend surgical removal of the uterus.

Prevention

Since the cause of adenomyosis is not known with certainty, there is no fully effective prevention method in avoiding the occurrence of this condition.