Adenomyosis

Definition - What does Adenomyosis mean?

Adenomyosis is a condition in which endometrial cells (from the inner lining of the uterus) penetrate the muscular layer of the uterus, called the myometrium. These cells then continue to follow hormonal cues to produce blood-rich endometrial tissue, but their location inside the wall of the uterine muscle causes severe discomfort and can damage the uterine muscle.

Adenomyosis is often described as endometriosis of the uterus and can result in increased risk of miscarriage due to damage to the uterus.

FertilitySmarts explains Adenomyosis

Normally, endometrial cells function to produce thick, blood-rich uterine lining tissue in preparation for nurturing a fertilized egg. These cells grow quickly in response to hormonal promptings after the previous cycle's uterine lining has been shed.

When these cells infiltrate the myometrium and grow inside of it, exaggerated symptoms of menstruation can occur due to the presence of excess menstrual tissue.

Additional symptoms of pain in the abdomen, pelvis, or during sex can be caused by damage to the myometrial muscle as the endometrial tissue grows throughout the menstrual cycle.

Symptoms of adenomyosis include:

  • Heavy or prolonged menstrual bleeding
  • Severe cramping or sharp pains during menstruation
  • Prolonged menstrual cramps that last throughout menstruation
  • Abdominal pressure or bloating
  • Abdominal pain that worsens throughout the menstrual cycle
  • Pain during intercourse
  • Passing of large clots during menstruation

Over time, adenomyosis can damage the ability of the myometrial muscle to expand and contract. This creates an increased risk of miscarriage, most frequently in the second and third trimester of pregnancy as the muscle fails to expand properly to accommodate the growing fetus.

Adenomyosis can occur at any age but is most common in older women. Those who have had past uterine surgeries such as fibroid removal, and those who have given birth in the past, are also at increased risk.

Diagnosis of adenomyosis can be difficult due to the similarity of symptoms to those of endometriosis. Pelvic exams, ultrasounds, and MRIs can assist doctors in determining if there is endometrial tissue inside the uterine muscle.

A biopsy of the uterine muscle may also be conducted, although such biopsies often yield false negatives due to the uneven dispersal of endometrial tissue within the uterine muscle. The section of uterine muscle selected for biopsy may be normal, even if other parts of the muscle are experiencing adenomyosis.

Many treatments for adenomyosis exists. Unfortunately, some of these negatively impact fertility. Treatments for adenomyosis include:

  • Medications, such as anti-inflammatory drugs and hormones
  • Minor surgeries such as uterine artery embolization and endometrial ablation
  • Hysterectomy

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