THIS WEEKS FEATURE: What is Adenomyosis?

Often referred to as Endometriosis’ brother or cousin, this again is another gynaecology condition with limited treatment and managements.

Adenomyosis, similar to Endometriosis, is when endometrial growths and tissue begins to grow and attach itself to the myometrium – the thick, muscular layer of the uterus (basically a fancy name for Endometriosis of the uterus).  It differs from Endometriosis, as Endometriosis disease does not penetrate muscular structures, however it is common that an individual can be diagnosed with both.

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Much like it’s neighbouring disease, Adenomyosis has no known cause.  However, it is widely accepted that its development is associated with trauma or injury to the uterus (e.g. c-section) that breaks the barrier between the endometrium (inner tissue layer of the uterus) and myometrium (muscular middle layer).  It is thought that trauma introduces a vicious circle of attempted healing and repair.

The stereotypical signs and symptoms of Adenomyosis are very heavy and very prolonged periods, severe and disabling menstrual cramps and abdominal pressure and bloating.  You can see from these 3 symptoms alone how similar this disease is to Endometriosis.  Other symptoms include but are not limited to;

  • chronic pelvic pain
  • abnormal uterine bleeding
  • painful intercourse
  • a “bearing down” feeling
  • a “dragging sensation”
  • pressure on the bladder
  • pain and/or a “dragging sensation” that travels down the legs
  • uterine enlargement
  • tender uterus
  • fertility problems

Just as with Endometriosis, it is common for patients with Adenomyosis to be diagnosed with other gynaecological conditions such as uterine fibroids and polyps.

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For me, my Adenomyosis symptoms do vary from the Endometriosis ones.  Although there is a crossover of period ones, I have found my cycle has become so much more painful and the cramps much more intense.  I also have a sensation that my uterus is going to fall out of my vagina.

To diagnose Adenomyosis, the only definitive method is a hysterectomy where the entire uterus is then sent of for pathology/laboratory testing.  However, it can be possible to see the clinical signs of Adenomyosis via ultrasound or MRI or through a laparoscopy.  Mine was identified through my third laparoscopy.

The treatment of Adenomyosis is just as or if not more tricky that with Endometriosis.  Typically, a hysterectomy is the “gold standard” of treatment, as it will be removing the affected body part thus resolving symptoms.  Many women find relieve with this option, but for some (like myself) it is a bit drastic.  Therefore, alternative methods include inducing the medical menopause or trying other hormonal treatments.  Before I was diagnosed, I spent 9 months in the medical menopause and my pain was relieved (I plan to do a future post on this), and my specialist consultant that I am currently under advised me that this was just as useful a diagnostic tool – the fact my symptoms were very severe and had changed before I was on it, and then disappeared whilst I was on it, and then came back very bad afterwards, suggested to him that it was Adenomyosis.

Other treatment methods include pain management and less severe surgical techniques such as uterine artery embolisation (a surgical procedure to block the uterine arteries, thus blood flow) and endometrial ablation (a technique where the lining of the uterus is reduced via laser).  However, since the new NHS guidelines have been introduced to reduce the number of “non-essential procedures” ablations are no longer offered to those with heavy menstrual bleeding, unless there is a pre-diagnosed condition.

Having both Adenomyosis and Endometriosis has been a challenge, particularly as both conditions affect fertility.  Adenomyosis patients are thought to have increased risk of misscarriages.  However, every patient is different, and fertility will differ as well.

There is currently no UK-based charity for Adenomyosis, but I have found quite a bit of support through online forums dedicated to women who have had hysterectomies or even HealthUnlocked (as forum used for all sorts of chronic health conditions).  Adenomyosis can be an isolating disease and limit what a person can do with their lives, but there is support available.  If you are struggling to search for information or want support, I hope this article helps.

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