Adenomyosis is a condition where the cells of the lining of the womb (endometrium) are found in the muscle wall of the womb (myometrium). Around one in 10 women will have adenomyosis. It can occur in any woman who still has periods but is most common in women aged 40-50 and in women who have had children. It cannot be spread between people and it is not cancerous.
Why does a patient get adenomyosis?
We do not know exactly why adenomyosis happens. One theory is that in certain conditions when the lining of the womb tries to heal itself after injury (e.g. after certain operations), this re-growth happens inwards instead of outwards, resulting in adenomyosis. It is likely that your genes, hormones and immune system may play a part as well. It is no one’s fault if adenomyosis occurs, and there are no known ways to prevent it.
What are the signs and symptoms?
The most common symptoms are:
- Heavy and / or painful periods
- Prolonged periods
- Pre-menstrual pelvic pain
- Feelings of heaviness or discomfort in the pelvis
- Pain during sexual intercourse
Around one third of women will not have any symptoms. It is a long-term condition and can affect many aspects of a woman’s life, including emotional wellbeing, relationships and daily routines. Any symptoms will stop when you enter the menopause.
Generally, adenomyosis does not decrease your chance of getting pregnant. Severe cases however might decrease fertility slightly and increase the chance of a miscarriage.
Do I need any tests to confirm the diagnosis?
It can take a long time (years even) to get to a diagnosis. This is because:
- Women may have very different symptoms
- Symptoms of pelvic pain can be caused by many other conditions
- Some women have no symptoms at all.
Unfortunately, this means that for many women, by the time they receive the diagnosis they may be starting to give up on getting the right help. In at least half of cases, adenomyosis can be detected by an internal transvaginal ultrasound scan. A probe is inserted into the vagina and images (created using high-frequency sound waves) are transmitted to a monitor. If an ultrasound scan does not clearly show you have adenomyosis, it may be necessary to have more expensive screening done e.g. magnetic resonance imaging (MRI) scan. This scan uses magnets and radio waves to produce a picture of the inside of your body.
What treatments are available?
Difficulty in diagnosing this condition has made it difficult to develop treatments, many of which address symptoms rather than the underlying cause. Before making a decision about treatment, you should be given full information about all the options including risks and benefits of each. Several factors may influence your decision-making, such as:
- Your age and how close you are to having the menopause
- Whether you want to become pregnant or not
- Treatments already tried in the past
- How you feel about surgery.
Depending on your situation, options could be:
- Doing nothing – if your symptoms are mild, you are trying for a baby, or you are nearing the menopause (when symptoms tend to stop anyway).
- Non-hormonal medicines (e.g. tranexamic acid and mefenamic acid) to help reduce pain and bleeding with your period.
- Hormonal medicines – this can include the combined oral contraceptive pill, progestogen-only pill or the medicated intra-uterine system (Mirena).
- Injections of hormones to create a false state of menopause – GnRH agonist injections shrink the womb lining by causing a temporary and reversible menopause (this is a short-term option only).
- Hysterectomy (surgery to remove the womb) can be an effective option for women who do not want to become pregnant – it’s not necessary to remove your ovaries so you should not enter the menopause after the hysterectomy. A hysterectomy can be performed via the laparoscopic route in order to limit invasiveness and decrease time of work.
- Uterine artery embolization – tiny particles are injected into your blood vessels through a catheter in the groin. The particles aim to cut off the blood supply to the womb and the adenomyosis. However, this treatment is extremely expensive and even though symptoms often improves initially they often recur in the future.
What happens if I do not receive treatment?
If you do not have any treatment the symptoms might stay the same or get worse over time. It always stops after the menopause.
Is there anything I can do to help myself?
Complementary therapies such as hot baths, yoga and gentle exercise may help with painful periods. Some women find that changing their diet is helpful. While most of these treatments are very relaxing, improvement in pain scores remains only marginal.