go back

Adenomyosis is a medical condition characterized by the presence of glandular tissue that normally lines the uterus (endometrium) in the muscle of the uterus. Sometimes it is called endometriosis of the uterus, although endometriosis and adenomyosis are rarely seen together.

The condition is typically found in women between the ages of 35 and 50, although any menstruating woman can have this painful condition. Patients with adenomyosis have painful and/or heavy menstrual cycles, which can be associated with blood clots and severe cramps. Because the endometrial glands are trapped in the uterine muscle, it is possible to have increased
pain without increased bleeding.

Adenomyosis may involve the uterus focally, creating an adenomyoma tumor or it can have diffuse involvement creating a bulky and heavy uterus.

The cause of adenomyosis is unknown, although it has been associated with any sort of uterine trauma that may break the barrier between the ndometrium and myometrium, such as a caesarean section, tubal ligation, pregnancy termination, or any pregnancy. Adenomyosis is responsive to estrogen; therefore it can go away with menopause, but reappear with hormone replacement therapy.

Adenomyosis may be imaged using an ultrasound, however MRI) is a far better non-invasive diagnostic tool. Transvaginal ultrasound is the most cost effective and most available. Either modality will show an enlarged uterus. MRI provides better diagnostic capability due to the increased soft tissue differentiation. MRI is better able to differentiate adenomyosis from
multiple small fibroids.

The exact diagnosis of adenomyosis only possible in a pathology specimen after a hysterectomy has been performed. Non-invasive treatment options range from use of ibuprofen, naproxen or other NSAID, hormonal suppression with birth control pills or progesterone pills or shots. However the only permanent cure option for adenomyosis is a hysterectomy. Although endometrial ablation can cure some women with dysfunctional uterine bleeding, patient with adenomyosis often fail endometrial ablation because the ablation only affects the surface endometrial tissue, not the tissue that has grown into the muscle. This remaining tissue often continues to grow and cause pain. If an endometrial ablation fails, the only treatment left is a hysterectomy.

Endometriosis is a debilitating condition in females in which cells similar to endometrial cells appear and grow in areas outside the uterine lining. These endometrial-like cells are influenced by hormonal changes and respond similarly as do those cells found inside the uterus; grow and shed. Symptoms such as severe acute or chronic pelvic pain often worsen in time with the menstrual cycle. Endometriosis is typically seen during the reproductive years, in roughly 5% to 10% of women, and is a common cause of infertility. The most common sites are in the ovaries, fallopian tubes, behind the uterus, on the bladder and on the intestines.

The major symptoms of endometriosis are acute, chronic or recurring pelvic pain, which can be mild to severe cramping occurring on both sides of the pelvis, to the lower back and rectal area pain, and even pain down the legs. The amount of pain a woman feels is not necessarily related to the extent of endometriosis. Some women will have little or no pain despite having extensive endometriosis affecting large areas or having endometriosis with scarring. On the other hand, women may have severe pain even though they have only a few small areas of endometriosis. Other symptoms of endometriosis include disabling cramps, lower back pain or abdominal pain, painful sex, urinary urgency or frequency, and even sometimes painful voiding.

Additional, symptoms can include nausea, vomiting, fainting, dizzy spells, frequent or constant menstrual flow, chronic fatigue, heavy or long uncontrollable menstrual periods with small or large blood clots, mood swings, extreme pain in legs, thighs or back. Adhesions or scar tissue may bind an ovary to the side of the pelvic wall, or adhesions may extend between the bladder and the bowel, uterus, etc. Women have also complained of extreme pain from frequent ovarian cysts, extreme pain with or without the presence of menses, premenstrual spotting, as well as fever, headaches, depression, hypoglycemia and anxiety.

Most endometriosis is found on these structures in the pelvis where it can produce mild, moderate, and/or severe pain felt in the pelvis and/or lower back areas. The pain is often more severe before, during, and just after the menstrual period.

Bowel endometriosis affects approximately 10% of women with endometriosis, and can cause severe pain with bowel movements. Endometriosis may spread to the cervix and vaginal or to sites of a surgical abdominal incision. Less commonly lesions can be found on the diaphragm and may inflict cyclic pain of the right shoulder just before and during menses. Rarely, endometriosis can be found in the lungs and brain. Endometriosis may also present with skin lesions.

While there is no cure for endometriosis, in many patients menopause (natural or surgical) will abate the process. In women desiring future fertility endometriosis is managed symptomatically, with the goal to provide pain relief, to restrict progression of the process, and to restore or preserve fertility where needed. Surgical treatment attempts to remove endometrial tissue and preserving the ovaries without damaging normal tissue can be attempting in women who still desire fertility. In women who do not want fertility, hysterectomy with or without the removal of the ovaries may be an option. There is no guarantee that the endometriosis or the symptoms of endometriosis will not come back, and surgery may create adhesions which can lead to complications.

When diagnose of endometriosis is confirmed during surgery treatment can be taken; the type of treatment depends on whether the patient wants future fertility.