Adenomyosis is a disease that is quite similar to endometriosis. It causes pain and discomfort in women who have the condition. Like endometriosis, adenomyosis is an accumulation of endometrial tissue outside the proper place (the uterine cavity). But unlike endometriosis, adenomyosis is only found in the internal muscle layer of the uterus, the myometrium.
The myometrium is a sensitive region, and the accumulation of endometrial tissue in this area can cause severe pain as soon as a woman begins menstruating, since every time she bleeds during her period, these small fragments bleed as well and cause intense pain during menstruation, just as with endometriosis. The challenge lies in diagnosing the problem, as some women are not even suspicious that something is wrong. For this reason, it is worth paying attention to some characteristic symptoms of adenomyosis, such as:
- Severely strong menstrual cramps
- Pain during sexual intercourse
- Altered menstrual flow with clots and heavy bleeding
- Pain when going to the bathroom (bowel movements)
There are several causes of adenomyosis, ranging from having more than one childbirth in a woman’s reproductive life to early menarche, before the age of 10. In women who have given birth, symptoms may appear 1 to 3 years after the first delivery. This can occur in cases of delivery where the myometrium had to be cut (cesarean), but a woman who had a normal delivery can also develop this health problem.
How Is Adenomyosis Diagnosed?
Besides the symptoms, the doctor will conduct specific tests such as ultrasound to diagnose it. In addition to these, clinical exams can also be performed, as well as more complex imaging tests like magnetic resonance and tomography. These will certainly give a precise diagnosis and even determine the severity of the adenomyosis. A significant increase in uterine size is one factor that can lead to diagnosis, but it must be associated with other factors mentioned above. Speaking of which, this disease has two types: localized and diffuse. In the localized form, the disease affects only one part of the endometrial tissue and surrounding glands, but just in a specific spot. In the diffuse form, the affected area is broader and sometimes involves a large part of the uterine walls.
Because adenomyosis is a uterine muscular disease, it can affect the muscle layer lightly (superficially) or even in an intermediate to deep way. The higher the degree, the more symptoms the woman will experience. This is because when menstruation arrives, the myometrium contracts to expel the blood stored inside it, and since it accumulates blood, the pain will be felt more intensely than in women who do not have adenomyosis.
What Is the Treatment for Adenomyosis and How Does It Affect Fertility?
Treatment for this female problem in women who still want to become pregnant is, in most cases, based on hormones (progesterone), since it is a disease caused by estrogen (increased estrogen levels). These hormones will inhibit menstruation and thus will certainly reduce the effects of the disease, such as pain. The doctor may also suggest surgery as a treatment. However, in this case, it involves removing the uterus entirely, which is obviously not a good option for women who have not yet had children. Therefore, if you have adenomyosis and still want to get pregnant, you may opt for treatments using anti-inflammatories and pain medications during the menstrual period.
Adenomyosis can also interfere with fertility in ways a woman might not imagine. As with endometriosis, there is no concrete reason for a woman to have difficulty getting pregnant, but studies show that it may cause involuntary contractions outside the menstrual period and lead to a miscarriage soon after implantation, or even prevent implantation from occurring at all. It’s not that it prevents pregnancy, but embryo implantation may be at risk if the disease is not treated in time. It is recommended that before starting to try to conceive, a woman should undergo intensive treatment with progesterone to reduce blood flow outside the endometrium. However, the only complete cure for the disease will be with the onset of menopause or with total removal of the uterus.
Living with adenomyosis can be torture for those who want to be mothers, but it is worth talking to a competent doctor about treatment options before starting the journey of trying and motherhood. If you experience two or more of the symptoms mentioned above, see a doctor as soon as possible and get clarification.
Also see: Menstruation with Skin Fragments – Now What?
Photo: Kate Sumbler, Ant Jackson
