All about Adenomyosis

Adenomyosis is a non-cancerous condition of the uterus that can mimic many of the signs and symptoms of fibroids. This condition results from the lining cells of the uterus growing directly into the muscle wall of the uterus. At the time of the menstrual period, these cells in the muscle bleed as well. And bleeding directly into the muscle causes pain. As the blood accumulates, the surrounding muscle swells and forms fibrous tissue in response to the irritation. This swollen area within the uterine muscle wall, called an adenomyoma, feels very much like a fibroid on examination and is often confused with a fibroid on a sonogram.
When this condition involves the entire uterus,  it becomes bulky and heavier called diffuse adenomyosis or uterine endometriosis.


Diagnosis of Adenomyosis

Ultrasonography shows bulky uterus with adenomyoma cyst which looks like small fibroid

The diagnosis of adenomyosis is suspected if the uterus feels enlarged and tender to the touch during the pelvic examination and patient gives history of excessive painful bleeding. However, this findings may also be seen in fibroids endometriosis or uterine polyps.

The uterus may be imaged using ultrasound (US) or magnetic resonance imaging (MRI). Transvaginal ultrasound is the most cost effective and widely available. Either modality may show an enlarged uterus. On ultrasound, the uterus will have a heterogeneous texture, without the focal well-defined masses that characterize uterine fibroids.

MRI provides better diagnostic capability due to the increased soft tissue differentiation and able to differentiate adenomyosis from multiple small uterine fibroids. The uterus will have a thickened junctional zone. A thickness of the junctional zone greater than 10 to 12 mm is diagnostic of adenomyosis (<8 mm is normal). Interspersed within the thickened, hypointense signal of the junctional zone, one will often see foci of hyperintensity (brightness) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage.
MRI can be used to classify adenomyosis based on the depth of penetration of the ectopic endometrium into the myometrium.


Symptoms of Adenomyosis

Adenomyosis may be mild and cause no symptoms at all, Though adenomyosis is considered a benign (not life-threatening) condition, it can have a negative impact on a woman’s quality of life. The common symptoms are: –

  • Heavy or prolonged menstrual bleeding
  • Severe menstrual cramping pain that worsen with age
  • Someone with adenomyosis might also feel pain during sexual activities.
  • Passing of blood clots during period, bleeding between periods or light spotting.
  • Bladder pressure leading to a constant urge to urinate
  • Pressure on bowel, leading to constipation and bloating
  • Abnormally enlarged abdomen
  • The uterus might also increase in size and feel very tender to the touch.

Cause of Adenomyosis

  • Although the cause of adenomyosis is not known, there are some speculative theories about what might trigger this painful condition.
  • Some doctors believe procedures such as a cesarean section can promote the invasion of the endometrial cells into the uterine walls.
  • Adenomyosis begins during the development of the uterus during fetal development by the endometrial tissue being deposited into the uterine muscle while you are still a female fetus.
  • There is also speculation that adenomyosis is caused by uterine inflammation during childbirth. During the postpartum stage, an inflammation of the uterine lining can occur. This inflammation might break the normal boundaries of the cells within the uterine wall.
  • One aspect that doctors can agree on however is that the growth directly depends upon the production of estrogen. Women who have decreased estrogen production due to menopause will see the adenomyosis go away on its own.
  • Since the cause is not exactly known, it is also a little hard to narrow down all of the risk factors associated with the condition. Childbirth and prior uterine surgery are the only two risk factors associated with adenomyosis that are known at this time. Anytime you have a surgery on your uterus, you are at a higher risk for developing adenomyosis due to the possible break in the uterine wall.
  • Cesarean section and removals of fibroids are the two most common uterine surgeries that could cause this condition.

Impact on Lifestyle due to Adenomyosis

Adenomyosis is a painful condition but overall is not harmful to your body. The excessive bleeding can have an effect on your daily life and so can the unbearable pain, which might cause you to feel very uncomfortable. You might not find activities as enjoyable as you used to because the risk of bleeding during the activity. Painful periods are also a problem and can affect your work or school routine, often leaving you calling in sick. The painful periods could also affect your romantic life and make having a relationship difficult. The pain could lead to anxiety, depression, irritability and feelings of helplessness. You should always seek medical attention if you feel any symptoms related to adenomyosis, so that you can find appropriate treatment options to help you cope with the condition

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