Summary about Disease
Uterine adenomyosis is a condition where the endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus (the myometrium). This misplaced tissue continues to act as it normally would — thickening, breaking down, and bleeding — during each menstrual cycle. This can lead to an enlarged uterus, painful and heavy periods, and pelvic pain. It's a benign (non-cancerous) condition, but the symptoms can significantly impact a woman's quality of life.
Symptoms
Common symptoms of adenomyosis include:
Heavy or prolonged menstrual bleeding (menorrhagia)
Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
Chronic pelvic pain
Painful intercourse (dyspareunia)
Enlarged uterus
Passing blood clots during your period
Tenderness in the lower abdomen
In some cases, adenomyosis causes no symptoms (asymptomatic)
Causes
The exact cause of adenomyosis is not fully understood, but several theories exist:
Invasive tissue growth: Endometrial cells from the uterine lining invade the muscle wall.
Developmental origins: Endometrial tissue may be deposited in the uterine muscle during fetal development.
Uterine inflammation related to childbirth: Inflammation of the uterus during the postpartum period might cause a disruption of the normal boundary of cells that line the uterus.
Stem cell origin: Stem cells in the uterine muscle may develop into endometrial tissue. Risk factors can include prior uterine surgery, childbirth, and being in the late reproductive years.
Medicine Used
Medical treatments for adenomyosis focus on managing pain and heavy bleeding. Common medications include:
Pain relievers: Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve) can help ease mild pain.
Hormonal medications:
Hormonal birth control: Combination birth control pills or progestin-only pills can help reduce heavy bleeding and pain.
Levonorgestrel-releasing intrauterine device (IUD): This IUD releases progestin and can reduce heavy bleeding and pain.
Gonadotropin-releasing hormone (GnRH) agonists: These medications can temporarily stop menstruation and reduce adenomyosis, but are often used as a short-term solution due to side effects.
Aromatase inhibitors: These drugs lower estrogen levels and can provide pain relief, though more research is needed.
Tranexamic acid: This non-hormonal medication can reduce heavy menstrual bleeding.
Is Communicable
No, adenomyosis is not communicable. It is not caused by an infection and cannot be spread from one person to another.
Precautions
There are no specific precautions to prevent adenomyosis, as the exact cause is unknown. However, some factors may be considered:
Managing estrogen levels: As adenomyosis is an estrogen-dependent condition, maintaining a healthy weight and lifestyle may help regulate estrogen levels.
Early intervention for symptoms: If you experience symptoms such as heavy or painful periods, seeking early medical evaluation and treatment may help manage the condition.
How long does an outbreak last?
Adenomyosis is not an "outbreak" but a chronic condition. The symptoms, such as heavy bleeding and pain, fluctuate with the menstrual cycle and can persist for as long as a woman is menstruating, typically until menopause. Without treatment, symptoms can be ongoing.
How is it diagnosed?
Adenomyosis is typically diagnosed through a combination of:
Medical history and physical exam: The doctor will ask about your symptoms and medical history.
Pelvic exam: To evaluate the size and shape of your uterus.
Imaging tests:
Transvaginal ultrasound: A probe is inserted into the vagina to create images of the uterus.
Magnetic resonance imaging (MRI): Provides detailed images of the uterus and can help differentiate adenomyosis from other conditions.
Endometrial biopsy: To rule out other conditions, such as endometrial cancer, a sample of the uterine lining may be taken.
Timeline of Symptoms
The timeline of adenomyosis symptoms can vary:
Symptoms may develop gradually over time, becoming more severe with each menstrual cycle.
Some women may experience symptoms starting in their 30s or 40s, particularly after having children.
The symptoms typically worsen until menopause, when estrogen levels decline, and the condition usually resolves.
There may be periods of time when symptoms are milder, followed by periods of increased severity.
Important Considerations
Important considerations for women with adenomyosis include:
Impact on fertility: Adenomyosis can sometimes affect fertility, although many women with the condition can still conceive.
Co-occurrence with other conditions: Adenomyosis can coexist with other conditions, such as endometriosis and uterine fibroids.
Treatment options: Treatment options range from medical management to surgical intervention, depending on the severity of symptoms and the woman's desire for future fertility.
Quality of life: Adenomyosis can significantly impact a woman's quality of life due to pain, heavy bleeding, and fatigue.
Hysterectomy: While not always necessary, hysterectomy (surgical removal of the uterus) is sometimes considered as a definitive treatment option for women with severe symptoms who do not desire future fertility.