You may have heard number of women facing lot of problem during her menstrual cycle like pain in lower abdomen, bloating, heavy bleeding, large blood clots, sudden vaginal discharge, nausea, enlarged uterus like appearance of 3 to 9 months pregnancy. If you encounter all these symptoms which are associated with adenomyosis, then it’s an alarming time to visit doctor.
Adenomyosis is defined as the presence of endometrial glands that appear within the tissue in the muscles of uterus. The muscular overgrowth causes the endometrial gland to get trapped in the myometrium resulting in problems during menstruation. The benign tumor interferes with the blood flow to the uterine lining. The endometrial tissue then begins to bleed during menstruation. The normal tissue passes through menses but the old uterine lining is not able to undergo normal shedding process and gets trapped, causing excruciating pain during menses. Some women with adenomyosis do not experience any symptoms, while others may have severe, unbearable symptoms. Adenomyosis is seen in women above 30 to 50 years and who have had children. Rarely is seen in young girls.
There are 3 different types of adenomyosis:
- Focal adenomyosis – adenomyosis in one particular site of uterus
- Adenomyoma – it is form of focal adenomyosis, but it is more extensive, as it results in uterine mass or benign tumor
- Diffuse – as the name suggest, the adenomyosis is spread throughout the uterus
- Abnormal blood clots during menses
- Bearing down sensation in the uterus
- Bladder pressure with frequent or obstructed urination
- Heavy and prolonged periods lasting up to 8 to 12 days
- Intense pain during intercourse
- Pulling /dragging sensation running down the thighs and legs
- Severe pelvic discomfort and pain during menses
The exact cause of adenomyosis is still not known. Scientists believe that there is link between the condition and various hormones like estrogen, progesterone, prolactin and FSH. Any imbalance of these hormones can result into adenomyosis. Some studies have shown that child bearing, previous uterine surgery, termination of pregnancy, short menstrual cycle and early age menarche may be risk factors for adenomyosis.
Physical examination might not be sufficient enough to confirm, as symptoms are common in other uterine disorders. If a doctor suspects adenomyosis, the first step will be pelvic examination which may reveal an enlarged and tender uterus. Transvaginal sonography may show enlarged and bulky uterus. MRI is the best imaging study to diagnose adenomyosis. The characteristic feature on an MRI is a thickened junctional zone, which is the thin innermost of myometrium. Sometimes adenomyosis can form a large cluster and is mistaken as fibroids. Sonographic features of adenomyosis include enlarged uterus, thickened endometrial lining and heterogeneous uterine wall. The only true and conclusive test to diagnose adenomyosis is a uterine muscle biopsy. This is invasive process and has potential to bleed. Research has found that about 62% of women find out that they had adenomyosis after hysterectomy, when tissue samples are fully evaluated via pathology.
- Drugs – Drugs which are used for endometriosis are also used to treat adenomyosis. For some, birth control relieves pain while for others it does not. If there is bleeding the main symptom, in presence of junctional zone thickening, then birth control pills and IUD are helpful. Not every patient is the same, so it is important that you discuss with your doctor any side effects that you might have from treatment.
- Laparoscopic deep excision surgery within the uterus: minimally invasive surgery of adenomyosis that is classified as either focal or adenomyoma. The surgeon is able to view and remove any harmful growing tissue within the uterus.
- Hysterectomy or partial hysterectomy: In this uterus or part of uterus is removed. It should be performed with caution and only in case of severe diffuse adenomyosis. A hysterectomy should be last approach when medication doesn’t work out.
Results in laser surgery are dramatic and pain relief from 70 to 100% may be achieved in 1 week, hence considered one of the best treatment options. Laser surgery works by directly visualizing ecotopic endometrial tissue under sonographic control and passing a laser fibre and laserising the ecotopic tissue. The laser surgery is particularly effective in focal adenomyosis as the ecotopic tissue is in the center of the adenoma.
Adenomyosis and Infertility
It is common in patients to have less fertility rates and in some cases infertility. This is because patients with adenomyosis are much more likely to develop endometriosis, which can have harmful effects when it comes to reproductive system. It is reported that patients suffering from adenomyosis will have:
- Fetal retardation rate of nearly 12%
- Pre-term birth rate of 24.4%
- Upto 50% miscarriage
Adenomyosis is not harmful disease. However, the symptoms can have negative impact on quality of life. Some people have excessive bleeding and pelvic pain that may prevent them from enjoying normal daily activities. Women become anemic, because of blood loss. This can cause fatigue, dizziness and moodiness which can lead to anxiety, depression, irritability and stress. Talk to your doctor openly, if any of the symptoms exist and get treated at the right time and right age. Early treatment can produce significant results. The possibility of endometrial cancer cannot be ruled out as this has been noticed in many cases.
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Radha K. Iyer is a contributing writer on Treatum Blog. When she is not writing, she can be found reading health and food blogs or experimenting with her culinary skills.
Disclaimer: The entire content of this article is for information purpose only and is not intended to replace a one-on-one relationship with a qualified health care professional. It is intended as a sharing of knowledge and information. It is not a substitute for professional care and should not be used for diagnosing or treating a health problem and disease.