Adenomyosis is a gynecologic condition that causes endometrial tissue in the lining of the uterus to grow into the muscular wall of the uterus. It enlarges the uterus and may lead to very heavy menstrual bleeding.
Because its symptoms are similar to that of several other conditions, it often takes years for women to get an accurate diagnosis.
Marshall Bovelsky, MD, a gynecologist with HealthFirst Medical Group, says that diagnosing adenomyosis is like putting a puzzle together. “It’s challenging. Your doctor may conclude that you have adenomyosis only after ruling out other possible causes for your signs and symptoms.
“In some instances, a sample of uterine tissue is collected for an endometrial biopsy to make sure you don’t have a more serious condition. But an endometrial biopsy won’t help your doctor confirm a diagnosis of adenomyosis,” he says.
“Pelvic imaging such as ultrasound and magnetic resonance imaging (MRI) can detect signs of adenomyosis, but the only way to confirm it is to examine the uterus after hysterectomy.”
What exactly is this painful condition that can leave women enduring pain and extremely heavy menstrual bleeding for years – and even decades – before it’s finally diagnosed?
Dr. Bovelsky explains, “Adenomyosis occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus. The displaced tissue continues to act normally – thickening, breaking down and bleeding – during each menstrual cycle. An enlarged uterus and painful, heavy periods can result.”
Experts say the condition has been historically under-reported and under-diagnosed, but current estimates point to adenomyosis affecting 20 percent to 35 percent of women.
Yale Medicine reports that doctors aren’t sure exactly what causes uterine adenomyosis.
However, evidence suggests that prolonged exposure to estrogen may be a contributing factor.
Women may be exposed to high estrogen levels if their menstrual cycles are shorter than average or if they have been pregnant two or more times. Exposure to other hormones, including progesterone, prolactin and follicle-stimulating hormone, and/or a history of uterine surgery, may also be causative.
Dr. Bovelsky adds that adenomyosis isn’t present in non-menstruating girls and that once a woman has gone through menopause it becomes a moot issue because adenomyosis disappears.
He explains that the nerves in the belly are different than those in the rest of your body. “It’s harder to localize pain in that area. Lots of things can cause it and many of the types of pain mimic each other,” making it hard to pinpoint the source of pain.
“It’s a chronic problem that waxes and wanes,” Dr. Bovelsky says.
Many cases of adenomyosis are found in women in their 40s and 50s and it is believed that adenomyosis in these women could relate to longer exposure to estrogen compared with younger women.
Cleveland Clinic says that – if left untreated – adenomyosis can lead to infertility or miscarriage. This is because the embryo cannot implant into the uterine lining.
Doctors use a variety of methods to ease pain and help with heavy bleeding and other symptoms:
- Pain medications: Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), ease cramping.
- Hormonal medications: Certain hormonal medications can help with menstruation and abnormal bleeding. Options include birth control pills, Depo-Provera injection and hormonal intrauterine devices (IUD), such as Mirena.
- Nonhormonal medication: Medications like tranexamic acid can reduce the amount of vaginal bleeding.
- Adenomyomectomy: This surgery removes adenomyosis from the uterine muscle. The procedure is similar to a myomectomy, which removes uterine fibroids.
- Hysterectomy: This surgery removes the uterus. After a hysterectomy, you won’t have a menstrual cycle or be able to get pregnant.
Women who bleed very heavily during their menstrual periods are at increased risk of anemia. Anemia develops when blood loss results in too few red blood cells in the body, so tissues do not receive enough oxygen. Anemia can lead to fatigue, dizziness, fainting, lightheadedness and shortness of breath.
“For these reasons, women who suffer from adenomyosis or are postmenopausal but dealt with it in the past, should talk to their primary care physician or OB/GYN,” says Dr. Bovelsky. “There are treatments, and it is not a condition you have to live with.”
Marshall Bovelsky, MD, is a gynecologist at HealthFirst Medical Group. He graduated from Wake Forest School of Medicine and University of Louisville School of Medicine. His offices are located at Health First Medical Group Gateway, 1223 Gateway Dr., Suite 1D, in Melbourne, and Health First Medical Group Malabar, 730 Malabar Road, Suite B, in Malabar.