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Adenomyosis is a condition similar to endometriosis, in that the endometrium that lines the uterus migrates to places that it shouldn’t be and causes pain. Instead of the endometrium being found on organs outside the uterus, it migrates through the muscle wall of the uterus (the myometrium) and implants there. These lesions cramp, bleed and spread just like endometriosis does. It can be located in one area of the uterus, or spread across the uterus muscles, making the uterine walls grow thicker. As with endometriosis, many women with adenomyosis will experience pain throughout the entire month, not just during their period.

Whilst awareness of endometriosis is rising, adenomyosis still remains under the radar – so much so that the NHS currently don’t even have an information page on it (although my sources inform me that they are currently in the process of making one). Many women are not fully aware of what adenomyosis is before they are diagnosed with it, and there is very limited information available on the internet.

Symptoms

The following list of symptoms are a general guideline of those experienced by women diagnosed with adenomyosis, but will vary from person to person. Some women are asymptomatic – they show no symptoms.

  • Heavy, prolonged periods
  • Severe menstrual cramps
  • Abdominal pressure
  • Bloating
  • Painful sex
  • Infertility
  • Spotting between periods
  • Blood clots during periods
  • Abdominal tenderness
  • Chronic fatigue
  • Depression
  • Anxiety

Diagnosis

Until recently, adenomyosis was diagnosed by performing a hysterectomy and having the uterine tissue examined under a microscope. Thankfully technology has made it possible to diagnose adenomyosis without having to permanently remove the uterus.

An MRI or transvaginal ultrasound can be used by doctors to look at the uterus and check for any signs of adenomyosis. If your doctor suspects adenomyosis, the first thing they will typically do is perform a physical exam – which may reveal an enlarged or tender uterus. An ultrasound will also allow the doctor to see the uterus, the lining and the muscular wall. Using an ultrasound will not be able to definitively diagnose adenomyosis, but it can indicate to the doctor whether they are on the right track and can rule out other potential conditions. Your doctor may also perform a hysteroscopy, where a camera and light (hysterscope) are used to examine the inside of the uterus, where they will be able to, more accurately, identify the presence of adenomyosis. It can present itself in a number of ways, including a mass of endometrial cells within the uterine wall. Adenomyosis has similar symptoms to fibroids, which as a more defined mass of cells or benign tumours found inside the uterine muscle/wall. During the diagnosis process, your doctor may believe that you have either of these diseases (it is possible to have both), but both will present slightly differently during exam.

Treatment

The only definitive cure for adenomyosis is a hysterectomy – an option which is not suitable for many younger people diagnosed with adenomyosis who still want to have a family. This option is usually taken by women who are suffering from very severe pain, and who have already had their family or do not want children.

Despite this, there are many ways that the pain can be managed. Most women use anti-inflammatories such as naproxen, ibuprofen and mefenamic acid. Hormone therapy, such as oral contraceptive tablets, are also used to manage the pain. Similarly to endometriosis, it is thought that adenomyosis thrives off oestrogen, and by reducing it within the body it limits its ability to grow, hopefully preventing the pain from worsening. Endometrial ablation is also used, this is a minimally invasive procedure which destroys the lining of the uterus (not as scary as it sounds!). If the adenomyosis has not progressed too far or penetrated deeply into the uterine muscle, ablation can be used to relieve the symptoms and the pain. Uterine artery embolisation is another treatment option where tiny particles are used to block the blood vessels that provide blood flow to the adenomyosis. With this blood flow cut off the adenomyosis is unable to grow, and may also shrink.